Outpatient Surgery Magazine

Manager's Guide to Ambulatory Anesthesia - July 2014

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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2 0 S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 4 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 SS_1407_Layout 1 7/1/14 2:24 PM Page 20

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