No. 1 priority apart from preserving the patient's safety and comfort
during the surgery. Here's my 5-point plan designed to make sure
patients get discharged with their stomachs settled — and your
facility's reputation intact.
1
Know your patient. PONV affects as many as 40% of
patients. Preventing it is all about ameliorating the risk based
on the patient's history, the nature of the surgery and gender.
Young women are more prone to PONV — as much as 3 times more
likely than men, in fact. Nonsmokers and anyone with a history of
migraines or motion sickness tend to be more at risk, too.
Ask patients if they have a history of PONV, but some patients might
not remember or might not even know that they're prone to PONV. So
do some legwork on the patient to see if you can learn more. You'll
learn more when you speak with the patient directly, so use your pre-
operative introduction as an opportunity to uncover more informa-
tion. When I contact a patient the night before surgery, I'll answer any
questions they might have and also ask a few of my own so I can com-
plete a formal assessment to gauge the likelihood of PONV. If the
patient is anxious and has a history of PONV, administer an antiemet-
ic like aprepitant or ondansetron. I'll also remind the patient of NPO
fasting guidelines, but if their case is later in the day I'll encourage
them to take some PO water or, if they have reason to think they
might suffer from withdrawal, some coffee.
2
Know the risks associated with the surgery. As a gen-
eral rule, the longer the surgery, the higher the risk of PONV,
though some surgeries by their very nature are more likely to
trigger PONV. GYN surgery, like a bilateral tubal ligation, or a breast
surgery, or anything that manipulates the equilibrium centers, like an
A P R I L 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 4 1