Do any of you have any experience in dealing with hyperbaric oxygen (HBO)therapy and the unit refusing to take your post-ops pts that received Phenergan intra-op?
I took care of a young lady that supposedly got PONV after her last surgery approximately one week ago. In examining the old chart, I saw that the PACU RNs gave Phenergan after the onset of N/V. I asked her if she had any episodes after the Phenergan and she said no. There were no further documented doses of Phenergan in the PACU. Her previous anesthetic record showed liberal amounts of hydration and Zofran administration.
Intra-op she recieved again liberal hydration, 4mg Zofran, and 12.5 mg of Phenergan in her IVF bag after induction during my case. Off to PACU we go. PACU RN states that the HOB unit will not take her due to having Phenergan on-board. I realize that Phenergan can lower the seizure threshold, but this young lady had no prior history of any abnormal neurologic activity.
Does the increased oxygen % atmosphere in the HBO place patients at additional risk for onset of seizures? Does phenergan and increased oxygen percentages act in a cumulative fashion for seizures?
I wonder if they limit patients for HBO therapy who dring Coke and coffee, both loaded with caffeine, which of course lowers the seizure threshold, and is often used in ECT's to "enhance" the seizures that are produced.
I bet there are no video games in the HBO treatment center, as we are all so well aware that blinking lights cause seizures.
What kind of procedure did she have? What I am wondering is the risk/benefit if HBO is indeed contraindicated after phenergan. Oh jeez, and good luck with that theory thing, whew.
I'm probably gonna date myself here, but I remember the coolest thing on the market was Sega and Sonic the Hedgehog actually had a warning for epileptics while the game cued up. And yes I did have the Atari system before that. My first computer was an Appple-II-E.
What kind of procedure did she have? What I am wondering is the risk/benefit if HBO is indeed contraindicated after phenergan. Oh jeez, and good luck with that theory thing, whew.
It was a young patient with vascular surgery. Can't say anymore than that...
I think it's kind of crazy to make those rules about patients who have never had a seizure or other neurologic symptoms and delay them immediate post-op HBO, but I bet 10 bucks they got fried at some point in the past and now we have a blanket situation that now applies to everyone, regardless.
I wonder if they limit patients for HBO therapy who dring Coke and coffee, both loaded with caffeine, which of course lowers the seizure threshold, and is often used in ECT's to "enhance" the seizures that are produced.
So caffeine enhances seizures and is used with ECT's....How do you get caffeine in a person for ECT and still have a good NPO status considering you are about to induce GA, even if for a brief period? You all doing IV caffeine down there?
yeah - IV caffeine - also used in neonates w/ apnea....
so they don't take patients who've had etomidate....brevital.....
i still think it is just a cop-out.
BTW - what was she having surg for - and what other meds did she have.... any versed...propofol...both of which will decrease the liklihood of seizures...and counteract this side effect of phenergan they are worried about....
yeah - IV caffeine - also used in neonates w/ apnea....
so they don't take patients who've had etomidate....brevital.....
i still think it is just a cop-out.
BTW - what was she having surg for - and what other meds did she have.... any versed...propofol...both of which will decrease the liklihood of seizures...and counteract this side effect of phenergan they are worried about....
Young patient with vascular surgery on an extremity.
Medications given in preop and surgery:
2 mgs versed preop
fentanyl - i forgot the amount, but fairly heavy dosing
propofol for induction
norcuron
fluids - LR
4 mg Zofran
12.5 mg Phenergan
Neo/Robinol
Morphine - probably 6-9 mg towards end of surgery
HBO unit totally focused on the phenergan. I'll probably get flamed for this, but it sounded like a typical knee-jerk, blanket reaction by staff RNs without considering the other variables. I just wondered if anyone else had heard of this.
Young patient with vascular surgery on an extremity.
Medications given in preop and surgery:
2 mgs versed preop
fentanyl - i forgot the amount, but fairly heavy dosing
propofol for induction
norcuron
fluids - LR
4 mg Zofran
12.5 mg Phenergan
Neo/Robinol
Morphine - probably 6-9 mg towards end of surgery
HBO unit totally focused on the phenergan. I'll probably get flamed for this, but it sounded like a typical knee-jerk, blanket reaction by staff RNs without considering the other variables. I just wondered if anyone else had heard of this.
Doesn't the HBO unit have a medical director? If you have a REAL HBO unit, plenty of patients are less then optimum - that's why they're there in the first place. The surgeon and the physician responsible for running the HBO unit should have a chat.
And yes - caffeine is available for IV use - 200mg in the vials that we use. :)
Doesn't the HBO unit have a medical director? If you have a REAL HBO unit, plenty of patients are less then optimum - that's why they're there in the first place. The surgeon and the physician responsible for running the HBO unit should have a chat.
And yes - caffeine is available for IV use - 200mg in the vials that we use. :)
We do indeed have a REAL unit considering we have a burn unit with integrated OR and a plastics residency here. I'm on-call Friday, going to get some answers.
Doh! I realized we had caffeine, just never did it for any of the ECTs I have done. Point taken.
I just wasted a couple of hours of my life, LOL, doing a search on this. I looked in pubmed, ovid, et. al. Found nothing. Let us know if you find out something...I tend agree with whoever said the doc had one bad experience...
We do indeed have a REAL unit considering we have a burn unit with integrated OR and a plastics residency here. I'm on-call Friday, going to get some answers.
Doh! I realized we had caffeine, just never did it for any of the ECTs I have done. Point taken.
It's kind of wierd giving something to have an even BETTER seizure. I never saw IV caffeine till I came to Atlanta - never saw it in my previous job. Now we don't do ECT's at all - what a shame
rn29306
533 Posts
I bet there are no video games in the HBO treatment center, as we are all so well aware that blinking lights cause seizures.