How do you treat PONV?
Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone.
What drug can be given to prevent PONV?
5-Hydroxytrytamine type 3 (5-HT3) receptor antagonists, and specifically ondansetron, are the most commonly used antiemetics for both prophylaxis and rescue treatment for PONV. Other first-line prophylactic antiemetics include dexamethasone, droperidol, and aprepitant for high-risk patients.
How can PONV be prevented?
Using combinations of antiemetics may be the most effective method of preventing PONV for high-risk patients. Dexamethasone plus a 5-HT3 receptor antagonist is an effective combination. This combination was superior to placebo in preventing early and late nausea and vomiting.
How common is PONV?
The average incidence of PONV after general anesthesia is about 30% in all post-surgical patients but up to 80% in high-risk patients despite advances in anesthetics and anesthesia techniques [1,2,3].
How long can PONV last?
Nausea and vomiting is a common and distressing symptom or side effect in medicine, surgery and following anaesthesia. It can cause complications such as wound dehiscence, electrolyte imbalance, increased pain, dehydration and aspiration. Generally, uncomplicated PONV rarely goes beyond 24 hours post-operatively.
What is PONV prophylaxis?
PONV prophylaxis should be considered for patients with moderate to high risk based on scoring system. Based on the level of risk, the patient can be treated with monotherapy or combination therapy of antiemetics along with nonpharmacologic approach and interventions for reducing baseline risk.
What is are the risk factors for PONV in the patient?
Female gender is the strongest patient specific predictor of PONV, followed by history of PONV or motion sickness, non-smoking status, and younger age. Anesthesia related factors include the use of volatile anesthetics, duration of anesthesia, perioperative opioid use, and use of nitrous oxide.
What is PONV medical term?
Postoperative nausea and vomiting (PONV) is a patient-important outcome; patients often rate PONV as worse than postoperative pain [1]. PONV usually resolves or is treated without sequelae, but may require unanticipated hospital admission and delay recovery room discharge [2,3].
Why do people get PONV?
PONV results from patient, surgical, and anesthetic factors. Surgical factors that confer increased risk for PONV include procedures of increased length and gynecological, abdominal, laparoscopic and ENT procedures, and strabismus procedures in children.
Why does PONV happen?
What is the treatment and Prevention of PONV?
Management of PONV involves a framework of risk assessment, multimodal risk reduction, and prophylactic measures, as well as prompt rescue treatment. There has been a significant paradigm shift in the approach towards PONV prevention. There have also been several emerging therapeutic options for PONV prophylaxis and treatment.
How is the risk of PONV risk assessed?
The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors. PONV prophylaxis is administered to patients with medium and high risks based on this scoring system.
How is PONV related to preoperative anesthesia factors?
PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors.
Are there any studies on intravenous lidocaine PONV?
Weibel et al 26 conducted a recent systematic review and meta-analysis (SRMA) on the use of intravenous lidocaine and included PONV as a secondary outcome; the PONV analysis included a total of 35 studies and 1,903 patients.
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