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October 17-21, 2009 New Orleans, LA Home Abstract Archive Search Abstracts 2009 Session Grid 2009 Meeting Website Policy Statements ASA Website Feedback 
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A1073
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
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| Dexamethasone and Ondansetron for PONV: Are We in a Rush To Administer? | |||||||||||||||||||||||||||||||||||
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Luis I. Rodriguez, M.D., Michael M. Vigoda, M.D., M.B.A., Mei-Ling Shyu, Ph.D., Tao Meng, M.S., Mitsunori Ogihara, Ph.D. Anesthesiology, Perioperative Medicine and Pain Management, University of Miami/Jackson Memorial Hospital, Miami, Florida |
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Introduction: Guidelines have been developed for the management of PONV [1,2]. The use of Dexamethasone (DEX) is most effective when administered before the induction of anesthesia rather than at the end [3], and Ondansetron (OND) is most effective when given at the end of surgery [4]. We hypothesized that anesthesia providers give treatment within the recommended times for each drug.
Methods: We reviewed 11,203 intraoperative records of surgeries performed between 01/2007 and 10/2008, considering only those cases where both DEX and OND were given. We determined the specific level of training (i.e., CA-1, CA-2, CA-3, CRNA) of the individual who documented giving an anti-emetic. Data from our anesthesia information system was used to specify the administration times of the 2 anti-emetics. The difference in time of administration between each drug was calculated: t= Ondansetron Administration Time - Dexamethasone Administration Time Results: Our analysis showed that 10.5% (1,171) received DEX, and 58% (6,504) received OND. OND was administered before DEX by CRNAs in 31% of their cases, and <10% by CA-1 and CA-2. OND-DEX Time difference <30 min was again highest in CRNAs, with 23% of their cases and lowest in CA-2, with 7% of their cases.[table1]Discussion: Following the recommended guidelines is important to decrease PONV and its associated complications such as increase in discharge time from the PACU. As DEX should be given immediately before induction and OND at the end of surgery, the OND-DEX time difference should be positive. Rarely will a surgical procedure at our institution end within 30 minutes of induction. Therefore, our finding that anesthesia providers administer OND within 30 minutes of DEX 15% to 54% of the time is worthy of further investigation. References: [1] TJ Gan, et al. Anesth Analg 2003;97:62-71 [2] ASPAN. J Perianesth Nurs 2006;21:230-250 [3] JJ Wang, et al. Anesth Analg 2000;91:136-9 [4] M Trame'r, et al. BMJ 1997;314:1088-92. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
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