Post-op Nausea/Vomiting

[RNfaster]

I am curious what surgeries folks have noticed are more prone to post-op nausea and vomiting... What works best to address it (either prophylactically or after the fact). Does it differ by the type of surgery? Other factors?

Here's an excerpt from an interesting article...

Rating an adult's risk for Post-operative nausea and vomiting

Risk factor (each worth one point)

* Female gender

* History of PONV or motion sickness

* Nonsmoker

* Intraoperative or postoperative opioid therapy

Prophylactic PONV therapy based on the patient's score:

* 0 to 1 point-no intervention, or transdermal scopolamine patch preoperatively; or preoperative dexamethasone; or total intravenous anesthesia (TIVA); or prochlorperazine given I.V. or I.M. at the end of surgery.

* 2 points-one or two of the following drugs: transdermal scopolamine patch preoperatively, I.V. dexamethasone preoperatively, TIVA, or prochlorperazine given I.V. or I.M. at the end of surgery.

* 3 or 4 points-three of the following drugs: transdermal scopolamine patch preoperatively, I.V. dexamethasone preoperatively, TIVA, prochlorperazine given I.V. or I.M. at the end of surgery, or dolasetron I.V. at the end of surgery.

The article also listed some surgeries and other risk factors, but I'd also like to hear what folks an allnurses.com have to say...

More from the article:

* * Type of surgery. Surgeries that are associated with a higher incidence of PONV include breast augmentation or other plastic surgery, strabismus repair or procedures associated with ophthalmology, otolaryngology, gynecology (especially with a laparoscopic approach), orthopedic and abdominal surgery, mastectomies and lumpectomies.5

Whether this is due to the type of surgical procedure, the length of the procedure, or the anesthetic agent used is unclear.11 *

Length of surgery. PONV and length of surgery are strongly correlated.5 In a patient with a surgical procedure taking less than 30 minutes, the risk of PONV is 28%; for a procedure that lasts 151 to 180 minutes, the risk of PONV is 46.2%.11 Longer surgeries may result in the patient receiving potentially emetogenic anesthetic agents over a longer time frame, resulting in the increased percentage of patients with PONV.18

* Medications. Chloroform and ether, although no longer used for anesthesia, had the highest probability of causing PONV.10 Newer anesthetic agents such as propofol, and the use of patient-controlled analgesia, spinal opioid administration, and total I.V. anesthesia (TIVA), have reduced the incidence of PONV to about 30%, compared with 80% during the era in which ether was used.12 However, nitrous oxide and volatile anesthetic agents such as isoflurane and enflurane, are all highly emetogenic, and general anesthesia causes more PONV than regional anesthesia. The use of opioids postoperatively about doubles the patient's risk for PONV.16 -

See more at: http://www.nursingcenter.com/lnc/cearticle?tid=1343404#sthash.DznxQHF2.QuG9VYe4.dpuf