ANESTHESIA


•  Reduction of risk (Anesth Analg 2007;105:1615–1628)


• Regional techniques (general anesthesia has 11-fold ↑ risk of PONV)


• Propofol (19% ↓ PONV risk compared to inhalational agents)


• Avoid nitrous oxide (12% ↓ PONV risk), inhaled anesthetics, neostigmine


• Minimize opioids


• Ensure adequate hydration



•  PONV rescue strategy


• If initial agent is ineffective → give drug from a different class


• Repeat droperidol and 5-HT3 antagonists q6h


• Repeat administration of dexamethasone not recommended


•  Discharge criteria


• Often based on formal scoring systems (see Chapter 13-6, PACU Management) or RN/MD assessment


• Oral intake: Not required prior to discharge


• Voiding: Only required if pt received neuraxial anesthesia or had gynecologic, hernial, anorectal, or genital surgery


• Spinal/epidural anesthesia: pt must have return of sensation & no motor block


• Nerve blocks: discharge can occur before full return of motor/sensory function, instruct pt to protect numb limb from injury





PAIN ISSUES FOR THE OUTPATIENT SETTING





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Aug 28, 2016 | Posted by in ANESTHESIA | Comments Off on ANESTHESIA

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