Document Detail


Pharmacological prophylaxis and management of adult postoperative/postdischarge nausea and vomiting.
MedLine Citation:
PMID:  17169748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.
Authors:
Julie Golembiewski; Sheri Tokumaru
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses     Volume:  21     ISSN:  1089-9472     ISO Abbreviation:  J. Perianesth. Nurs.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-15     Completed Date:  2007-02-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610507     Medline TA:  J Perianesth Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  385-97     Citation Subset:  N    
Affiliation:
Department of Pharmacy Practice (MC 886), University of Illinois at Chicago College of Pharmacy, 833 S Wood Street, Room 164, Chicago, IL 60612, USA. jgolemb@uic.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiemetics / administration & dosage,  adverse effects,  pharmacology,  therapeutic use*
Drug Therapy, Combination
Humans
Patient Discharge
Postoperative Nausea and Vomiting / drug therapy*,  prevention & control*
Risk Assessment
Chemical
Reg. No./Substance:
0/Antiemetics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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