Did you know some patients say that dealing with post-op nausea and vomiting (PONV) is even more uncomfortable for them than managing post-op pain? Here are 5 smart steps Outpatient Surgery magazine suggests your ASC can take to help prevent PONV from causing your patients serious discomfort following surgery.
1. Understand the patient’s history: Because PONV can be a problem for as many as 40 percent of patients, it’s worth reviewing the patient’s history of PONV prior to surgery to determine the best course of action for preventing it. Young female patients are 3 times as likely to have PONV than male patients. Patients who have a history of migraines or motion sickness are also at a higher risk. Prescribing an antiemetic drug like aprepitant or ondansetron can help prevent or relieve nausea and vomiting. It can also help to explain the importance of adhering to pre-op fasting guidelines for patients who have a higher risk of PONV.
2. Understand which surgeries can trigger PONV: Some procedures are worse than others when it comes to causing PONV. Longer surgeries tend to increase the risk of PONV as do gynecological and breast surgeries. Surgeries that impact the body’s equilibrium centers like eye-muscle surgery or inner-ear surgery are also strong candidates for causing PONV.
3. Choose anesthetics carefully: For patients with a known history of PONV, it’s best to skip volatile anesthetics like nitrous oxide in favor of a safer alternative whenever possible. Outpatient Surgery recommends a propofol infusion, regional anesthesia, or neuroaxial anesthesia.
4. Make a day-of-surgery game plan: To prevent PONV on the day of surgery, it’s important to keep the patient hydrated. If there is no contraindication, early use of IV hydration such as 20 mL per kilo of Ringer's or Plasma-Lyte can be more effective than a normal saline solution in preventing both PONV and hyperchloremic metabolic acidosis.
5. Don’t forget post-op follow-up: Check in with any patients who are at risk of PONV 24-48 hours after discharge to make sure they are not suffering from dehydration, pulmonary aspiration or electrolyte imbalance. Make sure they know how to reach you day or night in case their PONV worsens.
By taking these steps to prevent PONV you not only help make your patient’s post-op experience more comfortable, you also help boost your ASC’s reputation as a competent, caring facility.
Share Your PONV Secrets
We’d love to know how your facility helps patients manage PONV. Comment below to let us know what’s worked at your ASC.