Postoperatieve complicaties, exclusief respiratoire
Postoperatieve complicaties, exclusief respiratoire
Postoperatieve complicaties, exclusief respiratoire
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PONV Flow diagram<br />
Patient factors<br />
Female sex<br />
History of PONV<br />
or motion sickness<br />
Non-smoker<br />
Postoperative opioid use<br />
Surgical factors<br />
Laparoscopy<br />
Laparotomy<br />
Plastic surgery<br />
Major breast surgery<br />
Craniotomy<br />
Otolaryngologic procedures<br />
Strabismus surgery<br />
Mild to moderate risk Moderate to high risk Very high risk<br />
20-40%<br />
40-80%<br />
>80%<br />
1-2 factors present<br />
3-4 factors present<br />
>4 factors present<br />
Any one of the following<br />
Droperidol<br />
Dexamethasone<br />
Scopolamine<br />
Serotonin antagonist<br />
Droperidol plus<br />
Serotonin antagonist<br />
Or<br />
Dexamethasone plus<br />
Serotonin antagonist<br />
Combination antiemetics<br />
Plus<br />
Total intravenous<br />
Anesthesia with propofol<br />
Gan TJ 2002 JAMA<br />
Antiemetic treatment for PONV without<br />
Prophylaxis or if Prophylaxis Failed<br />
Initial Therapy<br />
Rescue treatment<br />
No prophylaxis or dexamethasone<br />
Low dose 5-HT 3 receptor antagonist<br />
Droperidol 0.625 mg<br />
Dexamethasone 2-4 mg<br />
Promethazine 6.25 mg<br />
5-HT 3 receptor antagonist<br />
Plus a second agent<br />
Antiemetic from a different class<br />
Triple therapy with 5-HT 3 receptor<br />
antagonist plus two other agents when<br />
PONV occurs < 6 hr postoperatively<br />
Triple therapy with 5-HT 3 receptor<br />
antagonist plus two other agents when<br />
PONV occurs > 6 hr postoperatively<br />
Do not repeat initial therapy<br />
Use antiemetic from a different class<br />
Use propofol 20 mg as needed in<br />
PACU (adults)<br />
Repeat low-dose 5-HT 3 receptor<br />
antagonist and droperidol but NOT<br />
dexamethasone or scopolamine<br />
Use an antiemetic from a different<br />
class<br />
23
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