Anesthesia PONV

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  1. Emetic Reflex Locations
    • Chemoreceptor Trigger Zone: Area Postrema
    • Higher cortical centers
    • Vomiting center: brainstem/medulla
  2. Chemoreceptor Trigger Zone Receptors
    • Dopamine: blood
    • Serotonin(5-HT): blood, CSF, and GI
    • Opioids and anesthetics
  3. Common Nausea and vomiting
    • Cancer chemo
    • Postoperative period
    • headache syndrome
    • Opioid use
  4. Risk Factors for PONV
    • Increasing age
    • Premenopausal women
    • Obesity
    • Previous history of PONV
    • Anxiety
    • Gastropareiesis
    • Type of surgery: laparoscopy, strabismus, middle ear
    • Length of Surgery
  5. Treatments for PONV
    • Ondansetron/granisetron
    • Droperidol/Haloperidol
    • Dexamethasone
    • Metoclopramide
    • Promethazine
    • Propofol
  6. Antidopaminergic Drugs
    • Butyrophenones: haloperidol
    • Phenothiazines
    • Domperidone
    • Metoclopramide (Reglan)
    • SA: Do not use with RLS, Parkinsons,or another disorder for dopaminergic drugs are used to treat
  7. H1-Receptor Agonists
    • Diphenhydramine
    • Promethazine (Phenergan): black box warning for chemical irritation and tissue damage 
    • SA: sedation, dizziness, headache, hypotension, urinary retetion.
  8. Muscarinic Antagonists
    • Scopolamine
    • SA: transdermal is less likely to cause effects of dry mouth, drowsiness, and blurred vision
  9. 5HT3-Receptor Antagonists
    • Ondansetron: Zofran
    • Dolasetron
    • Granisetron
    • SA: headache, constipation, prolonged QT
  10. Steroids
    • Dexamethasone: inhibits multiple inflammatory cytokines in the CNS and PNS. 
    • SAs: hyperglycemia, appetite changes, insomnia, mood swings, anxiety, headache. flossing, edema
  11. NK1 antagonists
    Aprepitant: Substance P antagonists
  12. Propofol
    Due to D2 antagonism, 5HT3 antagonism, or a cannabinoid agonis,

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Anesthesia PONV
2015-10-01 00:13:07
Anesthesia PONV

Anesthesia PONV
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