|
|
October 17-21, 2009 New Orleans, LA Home Abstract Archive Search Abstracts 2009 Session Grid 2009 Meeting Website Policy Statements ASA Website Feedback 
Visit Anesthesiology.org |
| Previous Abstract | Next Abstract |
| Printable Version |
|
A1076
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
| How Closely Do Attending Anesthesiologists Supervise PONV Prophylaxis Administration? |
|
**
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 |
|
Introduction: Postoperative nausea and vomiting (PONV) is the most frequent complication after anesthesia [1]. Guidelines have been developed for managing PONV [2,3]. The use of Dexamethasone is most effective when administered before the induction of anesthesia [4]. Serotonin Receptor Antagonists (Ondansetron) are most effective when given at the end of surgery [5]. We hypothesized that administration of PONV prophylaxis was consistent with SAMBA recommendations.
Methods: We reviewed 11,203 intraoperative records of surgeries performed between 01/2007 and 10/2008. We considered cases where there was a single supervising anesthesiologist (i.e., anesthesiologist was not relieved during the case) and dexamethasone and/or ondansetron was administered. For cases where dexamethasone was administered, we considered cases where an individual was the sole supervising anesthesiologist (ie, no relief attending) in ≥ 25 cases. The time of Dexamethasone administration was compared to the recorded “Time of Induction”. For cases where ondansetron was administered, we considered cases where an individual was the sole supervising anesthesiologist in ≥ 200 cases. The time of Dexamethasone administration was compared to the recorded “End of Surgery Time”. Results: In 62.5% (6,999) of cases ≥ 1 anti-emetic was administered. There were 15 anesthesiologists who each supervised ≥ 25 cases where Dexamethasone was administered. Administration occurred within ±30 min of induction in 30%-50% of cases. The legend in both Figures refers to the number of cases a specific attending supervised. There were 12 anesthesiologists who each supervised ≥ 200 cases where Ondansetron was administered. Administration occurred within ±30 min of surgery end in 50%-60% of cases. Discussion: Following recommended guidelines could decrease rates of PONV. However, in many cases the administration of Dexamethasone wasn't consistent with the recommendations. Ondansetron administration was even more troubling. For cases in which there was a single supervising anesthesiologist, 50-%-70% of the time administration occurred >30 minutes before surgery end. Some variation in administration time could depend on the anesthesia provider (Residents or CRNA) and not specifically on the supervising Anesthesiologist. Further studies are recommended to address the pattern of administration by anesthesiologist supervising other providers and differences from the guidelines.[figure1][figure2]References: [1] TJ Gan. Anesth Analg 2006;102:1884-98 [2] TJ Gan, et al. Anesth Analg 2003;97:62-71 [3] ASPAN. J Perianesth Nurs 2006;21:230-250 [4] JJ Wang, et al. Anesth Analg 2000;91:136-9 [5] M Trame'r, et al. BMJ 1997;314:1088-92. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
Figure 1
 Figure 2  |