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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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A1082
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
| Prophylactic Treatment for PONV – Are We Following the Guidelines? |
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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: Postoperative nausea and vomiting (PONV) is the most frequent complication after anesthesia [1]. Guidelines have been developed for the management of PONV [2,3]. The use of Dexamethasone is most effective when administered before the induction of anesthesia rather than at the end [4], and Serotonin Receptor Antagonists (Ondansetron) are most effective when given at the end of surgery [5]. We hypothesized that PONV prophylaxis interventions would follow SAMBA recommendations.
Methods: We reviewed 11,203 intraoperative records performed between 01/2007 and 10/2008. Dexamethasone and Ondansetron use was identified in each case. The time of Dexamethasone administration was compared to the recorded “Time of Induction”. The time of Ondansetron administration was compared to the “End of Surgery Time” in the Electronic Medical Record. Results: In 62.5% (6,999) of patients received some anti-emetic for prophylactic treatment of PONV. While 10.5% (1,171) received Dexamethasone, and 58% (6,504) received Ondansetron, some patients received both medications. When timing of administration was analyzed, Dexamethasone was administered “before induction” in 7.8% (91) of patients, and 37.8% (443) within ±30 min of induction. Ondansetron administration occurred within ±15 min of the “end of surgery” in only 13.1% (852) of cases. Appropriate time of administration is shown in both Figures as the gray colored bars. Discussion: Nausea and vomiting are the most undesirable postoperative outcomes [6], according to patient surveys. Decreased rates of PONV have been demonstrated when guideline recommendations are followed. However, our findings suggest that compliance with PONV guidelines is poor. Dexamethasone use prior to induction has been associated with uncomfortable sensations by patients, which could explain why approximately 30.1% (352) of patients receive the drug within 30 minutes after induction. We recommend further studies to address why anesthesia providers vary the PONV prophylactic drug use 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 [6] A Marcario, et al. Anesth Analg 1999;89:652-8. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
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