However, patient selection is critical. You need to rule out through pre-op phone calls and anesthesia assessment any high-risk factors such as obesity, uncontrolled medical problems (hypertension, diabetes, coronary artery disease, etc.), history of bleeding disorders, obstructive sleep apnea, history of difficult intubation, history of anesthetic complications (malignant hypertension) and recent fever or infection. It is imperative to exclude any patients who have difficult airway issues from surgery at an ASC, especially when performing an ACDF.
Post-operative nausea and vomiting remains a major morbidity associated with surgery and results in unplanned hospital admissions. Multimodal therapy is effective at reducing unanticipated hospital admissions secondary to intractable PONV. Pre-emptive therapy includes: zofran, reglan, decadron, use of versed and propofol at induction and avoidance of nitrous oxide. Rescue therapy includes: promethazine, a second dose of zofran, scopolamine patch, IV fluids and oxygen. Try to avoid antiemetics that may cause CNS effects (promethazine only when needed) and use zofran on all patients (reglan and decadron unless contraindicated).
Beth A. Johnson is the vice president of clinical systems for Blue Chip Surgical Partners. Learn more about Blue Chip Surgical Partners.
