Antiemetic Prophylaxis for Post-Operative Nausea and VomitingLuciana Frighetto, B.Sc. (Pharm), Carlo Marra, Pharm.D., Peter Loewen, Pharm.D.
Post-operative nausea and vomiting (PONV) are commonly reported adverse events after surgery and can contribute to the development of aspiration, wound dehiscence, and increased bleeding.1,2 Prophylaxis with antiemetics has been shown to reduce the incidence of PONV as well as improve patient satisfaction, decrease recovery and discharge times, and reduce hospital readmissions.3-10 There are many studies supporting the use of prophylactic antiemetics to reduce the incidence of PONV in patients at high risk for PONV.3,7-9,11-18 Several different antiemetics have been studied for the prevention of PONV including metoclopramide, perphenazine, droperidol, ondansetron and dolasetron.3-5,7,11,19-21 These agents have all been associated with varying degrees of success.
Currently, there are no standard guidelines for the prophylactic use of antiemetics in the management of PONV in our institution. CSU Pharmaceutical Sciences, in collaboration with the Department of Anesthesia, have developed standard protocols for the prevention and immediate post-operative treatment of patients with nausea and vomiting for both the ambulatory and inpatient settings. For the prevention of PONV, preprinted orders for anesthesia and Surgical Daycare Centre (SDCC) have been created for patients considered at high risk for PONV and include various antiemetic agents such as droperidol, dolasetron, and metoclopramide. Dolasetron, a Limited Access Drug at VHHSC, has now been approved by the Drugs and Therapeutics Committee and Medical Academic and Advisory Committee for use in the prophylaxis of PONV. This agent can be prescribed using a preprinted anesthesia or SDCC pre-op order form. Preprinted orders have also been created for the treatment of PONV in the post anaesthesia recovery and surgical daycare settings. These orders reflect a standard approach for the treatment of PONV in these settings.
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