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Know who's vulnerable
It's been assumed and expected that about 30% of patients will vomit
post-operatively and that many more will teeter on the brink. But obvi-
ously, having a 30% (or higher) patient dissatisfaction rate is no way to run an
OR.
Fortunately, you can plan ahead to try to reduce the suffering by recognizing
certain patients as high-risk and tailoring your treatment accordingly. There's no
fool-proof formula when it comes to determining who's susceptible and who
isn't, but not surprisingly, the strongest indicator is past experience with PONV.
Also strong candidates: People who are prone to motion sickness. Females are
more susceptible than males, the young are more susceptible than the elderly,
and curiously, people who don't smoke are more likely to be affected than those
who do.
That high levels of anxiety also make people more susceptible has generally
been disproved, but that doesn't mean that anxiety-reducing drugs hold no
value in the battle plan against PONV.
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Keep an open mind
Let patients participate in PONV-prevention efforts by having them apply
a scopolamine "cruise" patch behind an ear the night before the surgery.
The patches have been refined and improved over the years, so they're more
effective with fewer side effects.
Some patients may also arrive with acupressure wrist bands, inspired by
Chinese medicine and thought to diminish PONV by putting pressure over a cer-
tain spot on the wrist. There's nothing wrong with that. Some people of science
want to dismiss alternative approaches to PONV prevention, but studies show
they work.
P O N V
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