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Can the surgery be done with
regional anesthesia? If so, you'll
likely minimize the risk of PONV. If
not, can you avoid inhalation
agents by using propofol exclusive-
ly, via a continuous intravenous
stream? Can you adequately con-
trol pain with NSAIDs or acetamin-
ophen, thus eliminating the need for narcotics?
5
Follow through
Stay on top of the PONV prevention plan in post-op, where often it's
reflexive to order narcotics for patients who are experiencing dis-
comfort. If staff members are aware and communicating, they can look for
other ways to reduce pain without resorting to treatment that may make the
patient even more miserable. There's also likely to be a temptation to want
to get patients up and out quickly, but patients will respond better if you
keep the IV in place and keep them hydrated.
And when it comes to eating or drinking, don't force the issue. That's
something a lot of people aren't aware of. You do not want to force food or
fluids on patients who are prone to PONV. Some may want to eat, but not
want to drink. That's OK. Give them time. They'll eat and drink when they're
ready.
The 30% or more of patients who experience PONV are a big concern for any
facility that cares about patient satisfaction. Can you reduce the number to
zero? That's the goal you should be striving for, whether it's actually achievable
or not. OSM
Dr. Gayer (
sg a yer@mia mi.edu
) is chair of the American Society of Anesthesiologists'
Committee on Ambulatory Surgical Care, professor of anesthesiology and ophthalmolo-
gy at the University of Miami Miller School of Medicine, and chief of surgery and direc-
tor of anesthesia services at Bascom Palmer Eye Institute in Miami and Palm Beach,
Fla.
P O N V
FOOD FOR THOUGHT PONV-prone patients may not
feel like eating or drinking after surgery. The impor-
tant thing: Don't force the issue.
Lynda
Dowman
Simon,
RN
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