M
y career as a nurse anesthetist
recently began at two plastic
surgery centers, where I knew
I'd face significant challenges in
managing PONV. Rates of the
relatively common complication are often much
higher after plastics cases (35% to 40%) than after
other types of procedures (25% to 30%). Instead of
waiting to treat nauseous patients postoperatively, I
went on the offensive by using a personal protocol
that produced immediate positive results (see "A
Proactive Approach to PONV Prevention").
Incidence of PONV among my patients has
noticeably declined and PACU nurses report that
patients feel better, faster. As a result, patient satis-
faction at the surgery centers has significantly
improved. I've found out from firsthand experience
that it's important to prevent PONV, not treat it.
Doing so requires a perioperative strategy that will
achieve optimal outcomes for happier patients.
Understand the risks
Your first step in preventing PONV is identifying
patients who are most at risk. Generally, women,
specifically younger women, are at higher risk, as
are non-smokers and anyone with a known history
of PONV or motion sickness. The type and duration
of the procedure also plays a key role in the likeli-
hood of a patient developing PONV. Intraabdominal
or gynecologic procedures are believed to cause
more vomiting and nausea than other surgeries.
Lengthier procedures lead to longer exposure to
anesthesia gases, and volatile anesthetics and
nitrous oxide can cause nausea. Of course, when
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T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1
Ryan Wade, CRNA I Dallas
PONV Prevention Boosts Patient Satisfaction
Efforts to eliminate that queasy feeling improve the quality of care you provide.
TOUGH TO STOMACH Patients will remember feeling sick long after surgery, regardless of how well the procedure went.
Pamela
Bevelhymer
