Principles 2 Fall 2025 > Postop NV > Flashcards

Postop NV Flashcards

FINAL (60 cards)

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1
Q

______ is the most common pt complaint with anesthesia. The overall incident is ___% with some reaching __%. What is the incident of intractable vomiting?

A

PONV

20-30%

80%

0.1%

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2
Q

PONV peaks at ____ & is persistent for _______. What is the exact cause of PONV?

A

6hrs

24-48hrs

The exact cause of PONV is unknown – there are multiple factors that contribute to this.

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3
Q

What are the risk factors for PONV for adults? (6)

A
  1. Female
  2. Non-smoker
  3. Hx of PONV
  4. Hx of motion sickness
  5. Delayed gastric emptying
  6. Preop anxiety
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4
Q

What are anesthesia risk factors for PONV? (8)

A
  1. VA
  2. Nitrous (esp >50%)
  3. Opioids
  4. Neostigmine
  5. Pre-anesthetic medication
  6. Gastric distention
  7. Duration of anesthesia
  8. Mandatory PO fluids before d/c
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5
Q

T/F: with increase duration of anesthesia with propofol use the incident of vomiting increases compared to VA

A

F

With propofol the incidents of vomiting actually does not increase

VA does increase with duration of anesthesia

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6
Q

What are surgical risk factors for PONV? (8)

A
  1. Long duration of Sx

High risk sx:
2. Laparoscopy
3. ENT Sx
4. Neurosurgery
5. Laparotomy
6. Breast sx
7. Plastic sx
8. Strabismus Sx

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7
Q

What are pediatrics specific procedures that increase risk for a PONV? (5)

A
  1. Adenotonsillectomu
  2. Strabismus repair
  3. Hernia repair
  4. Orchiopexy
  5. Penile sx
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8
Q

In pediatrics, PONV risk _____ with age until puberty. It is equal in male & female until ________. What happens then?

A

Increases

Adolescence

Higher in female > male

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9
Q

T/F: you are equally likely to have PONV in adults and children

A

F

You are 2x more likely to vomit if you’re considered pediatric

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10
Q

What are strategies to reduce PONV? (11)

A
  1. Regional
  2. Propofol (TIVA, entire case or last hour)
  3. Introap supplemental O2
  4. Adequate hydration
  5. Avoid nitrous
  6. Avoid VA
  7. Avoid opioids
  8. Multimodal
  9. Surgical wound infiltration
  10. Minimize neostigmine
  11. Minimize excessive immediate motion
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11
Q

What are the concerns rt PONV? (9)

A
  1. Discomfort/dissatisfaction
  2. Tension on sutures – compromising wound closure
  3. Wound dehiscence
  4. Aspiration
  5. Dehydration/electrolyte imbalance
  6. IICP/IIOP
  7. Prolonged PACU
  8. Increase cost of care (longer stay, readmission, drugs, supplies)
  9. Increase use of personnel & resources
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12
Q

The cause of N/V (or prevention) is dt the emetic center which is located in the _______ of the _______. How does this area work?

A

Lateral reticular formation

Brainstem

Drugs target other areas that send afferent signals to the LRF (no substances act directly on it)

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13
Q

T/F: there are many drugs that act directly on the emetic center that increase NV

A

F

No substances act directly on the lateral reticular formation

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14
Q

Incoming stimuli to the emetic center which is considered __________ comes from _________ (5)

A

afferent input

  1. Pharynx
  2. GI tract
  3. Mediastinum

Higher brain centers:
4. Chemoreceptor trigger zone from area postrema
5. Vestibular portion of CN 8

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15
Q

The reticular formation is _______ to the brainstem. What is in the brainstem? (3)

A

anterior

  1. Midbrain
  2. Pons
  3. Medulla
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16
Q

CTZ =

A

Chemoreceptor trigger zone

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17
Q

CTZ has no ____. What does this cause?

A

Blood brain barrier (BBB)

Causes the area to be easily triggered by drugs in bloodstream/CSF

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18
Q

What are the receptors in the CTZ? (8 )

A
  1. Dopamine
  2. Serotonin
  3. 5-HT3
  4. Opioid
  5. Histamine
  6. Muscarinic
  7. Neurokinin-1
  8. Cannabinoid
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19
Q

What does data show about PONV management? (4)

A
  1. No single drug is gold standard
  2. Pts should NOT receive the same drug for prophylaxis & Tx
  3. Identify risks & prevent
  4. Preventing»_space;> treating
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20
Q

PONV incidence %: 1 receptor targeted

A

38%

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21
Q

PONV incidence %: 2 receptors targeted

A

28-30%

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22
Q

PONV incidence %: 3 receptors targeted

A

22%

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23
Q

What are the sedation drug effects on PONV? (2)

A
  1. Opioid increased risk
  2. Benzodiazepines decrease risk
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24
Q

What are the induction drug effects on PONV? (3)

A
  1. VA increased risk
  2. Ketamine, etomidate increase risk
  3. Propofol decrease risk
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25
Nitrous is associated with an _____ risk of PONV especially at _____
Increase 50% or more
26
T/F: a single dose of morphine is associated with PONV
T
27
What is the dose rt neostigmine with PONV? Why does it cause PONV?
> 2.5mg Anticholinergic/muscarinic effects --> actions on GI
28
What are the reversal drug effects on PONV? (3)
1. Neostigmine increases risk 2. Atropine reduces risk (preferred over glyco/neostigmine) 3. Give NMB that aren't reversed (???? I could just use suga??)
29
What are PACU protocols that have effects on PONV? (3)
1. Forcing position changes 2. Forcing ambulation 3. Forcing early PO fluids
30
The _______ is a predicting PONV scoring system, which developed a risk for. Give me all the risk factors and percentages.
Apfel 0 PONV risk factor = 10% chance of PONV 1 = 20% 2 = 39% 3 = 60% 4 = 79%
31
According to the Apfel scoring system, **prophylaxis for PONV is indicated** at _____ risk factors, which is associated with _____% risk of PONV
2 39%
32
PONV algorithm: low risk PONV + low risk medical sequela
Prophylaxis: none Rescue: 5-HT3 antagonist
33
PONV algorithm: low risk PONV + high risk medical sequela
Prophylaxis: 5-HT3 antagonist Rescue: Phenothiazine -antihistamine -metoclopramide
34
PONV algorithm: moderate risk PONV + any risk medical sequela
Prophylaxis: 5-HT3 antagonist + steroid Rescue: Phenothiazine -antihistamine -metoclopramide
35
PONV algorithm: high risk PONV + any risk medical sequela
Prophylaxis: 5-HT3 antagonist + steriod + propofol TIVA + scop Rescue: Phenothiazine -antihistamine -metoclopramide
36
Antidopaminergics, or _________ are antiemtics, but they are also _______ (2). What types of symptoms do they cause? (3) What are the subtypes? (2)
Dopamine receptor antagonist 1. Antipsychotics 2. neuroleptics symptoms: 1. Drowsiness 2. Sedation 3. Extrapyramidal symptoms (EPS) subtypes: 1. Butyrophenones 2. Phenothiazines
37
_______ (2) are Butyrophenones. Briefly describe each (2-4)
1. Haloperidol -IM use only (not FDA approved for IV) -Not FDA approved for PONV 2. Droperidol -dont use >0.625mg -as effective as Zofran 4mg -more effective with Reglan 10mg -acts as a weak Alpha blocker --> hypotension
38
What is the black box warning for a Droperidol?
Torsades & sudden death
39
What drugs are Phenothiazines? (3)
1. Prochlorperazine 2. Chlorpromazine 3. Promethazine
40
Describe Promethazine (3)
1. Antidopaminergic --> Phenothiazine 2. Antagonize: alpha, histamine, muscarinic, cholinergic receptors 3. SE: sedation, hypotension, extrapyramidal symptoms
41
What is the black box warning for promethazine?
1. Tissue damage 2. Respiratory arrest < 2yo
42
Drug dose: promethazine/Phenergan
12.5 - 25mg
43
5-HT3 antagonist are __________ that act on the receptors on the _______ (2). What are the SE of these medications? (3)
Serotonin antagonist 1. Vagus nerve 2. Chemoreceptor trigger zone SE: 1. HA 2. Constipation 3. Mild elevation of liver enzymes
44
What medications are 5-HT3 receptor antagonist? (4)
1. Dolasetron (Anzemet) 2. Granisetron (Kytril) 3. Ondansetron (zofran) 4. Palonosetron
45
Drug dose: Ondansetron (zofran)
4 mg
46
With zofran you give _____ within ____ of the surgery end.
4mg 15-20min
47
Scopalamine is a _________ that blocks _______. What are the SE? (3) where do we place this? (3)
Anticholinergic Acetylcholine SE: 1. Drowsiness 2. Dry mouth 3. Dizziness Placement: thin skin/vascular area 1. Behind ear 2. Inner ankle 3. Wrist
48
Drug dose: Scopalamine
1.5mg transdermal patch (leave in place 48-72hrs)
49
Metoclopamide (reglan) is a ________ that increases _________ (2). What are the SE? (2) Describe its half life.
Gastrokinetics 1. LES tone 2. GI motility SE: 1. Restlessness 2. Extrapyramidal symptoms (EPS) half life is short and may require redosing
50
Drug dose: Metoclopamide (reglan)
10 - 20mg IV
51
T/F: Metoclopamide (reglan) is more efficacious than droperidol & 1/2 the studies say its indistinguishable from saline
F Less efficacious than droperidol but the rest is also true :/
52
Aprepitant/Emend is a ___________. How does this medication work?
NK-1 antagonist Antagonizes substance P in the emetic center --> depresses neural activity of the nucleus tractus solitarius --> interferes with afferent messages from the enerochromaffin cells
53
Drug dose: Aprepitant/Emend
40mg or 125mg
54
Aprepitant/Emend is given __________ and have a greater effect on ________.
2-3 hours prior to induction antivomiting (vs anti nausea)
55
Drug dose: Propofol (sub hypnotic IVP/gtt)
10-20mg IVP 16.7 mcg/kg/min IV
56
Propofol blocks ____ release at ________ receptors. It may also inhibit __________.
Serotonin 5-HT3 receptors Chemoreceptor trigger zone
57
T/F: propofol is liver soluble therefore it can become contaminated if giving frequent IVP doses
T
58
59
What are non-pharmacological options for PONV? (6)
1. Pre-hydrate: 10-20 ml/kg 2. Carbohydrate loading 3. Aromatherapy: peppermints, alcohol (50% reduction in nausea) 4. Ginger (no significant reduction) 5. Chewing gum (improve nausea, stimulates motility) 6. Acupuncture
60
What are the 5 underlying causes that need to be corrected to help avoid PONV?
1. Hypotension 2. Hypoxemia 3. Elevated ICP 4. Gastric bleeding 5. Hypoglycemia
Principles 2 Fall 2025
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