Disclosure

Disclosure before surgery

CRNAs or anesthesia providers need to know if you are a patient with increased risk of postoperative nausea and vomiting (PONV).  Especially if you have mentioned this risk to your anesthesia provider.  Most patients rate that “PONV is a worse feeling after surgery than pain”.

Generally, if you are a female from ages 18-50, have a previous history of general anesthesia and PONV, and/or a history of motion sickness, and are a non-smoker then you are at risk of PONV after surgery.   Surgeries that increase PONV are, gynecology (GYN), breast surgery, sinus surgery, ear, nose, and throat (ENT),  and gastrointestinal (GI).

As CRNAs we have different medications in the preoperative area that can be given to patients before starting surgery, such as Emend (pill form) and scopolamine patch.  Emend is used for patients with a history of chemotherapy and nausea.  The Scopolamine patch is also used for patients with sea or motion sickness.

Other measures like Propofol infusions are used intraoperatively as an antiemetic.  This can be used at a high dose solely and no volatile agents used.

Both Decadron and Zofran can be used as anti-nausea drugs as well.

If I know I have a patient who is at high risk for PONV, I may use all drugs like Emend, scopolamine, Decadron, Propofol, and Zofran. 

Other measures to prevent PONV are to use less narcotics, and give Tylenol IV and NSAIDs like Toradol IV, if not contradicted by the surgeon.