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Sprejeto na sestanku SZAIM dne 24.5.2011 v Ljubljani

Standardni operativni postopek SZAIM Preprečevanje in zdravljenje pooperativne slabosti in bruhanja. Sprejeto na sestanku SZAIM dne 24.5.2011 v Ljubljani. PRISTOPI IN UKREPI – MOŽNOSTI. A: Znižanje osnovnega tveganja Splošna V regionalna anestezija

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Sprejeto na sestanku SZAIM dne 24.5.2011 v Ljubljani

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  1. Standardni operativni postopek SZAIMPreprečevanje in zdravljenje pooperativne slabosti in bruhanja Sprejeto na sestanku SZAIM dne 24.5.2011 v Ljubljani

  2. PRISTOPI IN UKREPI – MOŽNOSTI • A: Znižanje osnovnega tveganja • Splošna V regionalna anestezija • Uporaba propofola za indukcijo in vzdrzevanje anestezije • Izogib inhalacijskim anestetikom • Izogib dušikovemu oksidulu • Zmanjšana uporaba opioidov intra in pooperativno • Izogib dekurarizaciji • Zadostna hidracija

  3. B: 5 HT3 antagonisti (serotoninski): ob koncu posega

  4. C: Deksametazon ob indukciji • Odmerek: • odrasli 4-8 mg iv, • otroci 0.1 do 0.5/kg iv.

  5. D: Butirofenoni – ob koncu posega

  6. E: Dimenhidrinat (Dramina) • v tbl a 50mg v Sloveniji, • iv odmerek 0,5 - 1mg/kg,

  7. F: Fenotiazini (dopaminergični blokatorji) • prometazin (Fenargan) – antihistamin H1 blokator • proklorfenazin • tietilperazin (Torecan)

  8. G: dopaminski in 5HT antagonist

  9. H. Ne farmakološki in drugi proistopi k zdravljenju: • Ingver • Kanabinoidi • Hipnoza • Akupunktura, akupresura • TENS

  10. I. Novosti: • naloxone, • nalmefene, • almivopan, • nevrokinin1

  11. PREDLOGI KOMBINACIJ:

  12. ALGORITEM PREPREČEVANJA

  13. ALGORITEM ZDRAVLJENJA

  14. Guidelines for the Management of PONV, December 2007 – Algoritem for management of PONV Adult RiskFactors Patient RelatedEnvironmental History of PONV/motion sickness Postop opioodsFemale gender Emetogenic surgeryNon-smoker(type and duration) Consider Patient preferences Fear of PONVFrequency of PONV causing headaches/migrain Cost-effectiveness Reducing baseline risksAvoidance/minimization of: Nitrous oxideVolatile anestheticsHigh-dose neostigminPost-op opioids Level of Risk 0 RF = 10%1 RF = 10 – 20%2 RF = 30 – 40%3 RF = 50 – 60%4 RF = 70 – 80% Patient risk High ≥ 2 Interventios/Multimodal Approach Low Wait and see Medium Pick 1 or 2 Intervention for adults

  15. Guidelines for the Management of PONV, December 2007 – Algoritem for management of PONV Low Wait and see Medium Pick 1 or 2 Intervention for adults High ≥ 2 Interventios/Multimodal Approach Propofol Anesthesia RegionalAnesthesia Dexamethasone Droperidol or Haloperidol 5-HT3 antagonist Portfolio of prophylaxisand treatment Prometazine*Prochlorperazine*Perphenazine* Non-pharmacologyical Propofol in PACU(rescue only) Scopolamine Ephedrine* Dimen-hydrinate* *Lack or limited evidence of effect

  16. LITERATURA: • Postdischarge Nausea and Vomiting: Risk assessment &treatment strategies. Anaesthesiology News, 2005 • Consensus Guidelines for the Management of PONV. Anaesthesiology News, 2009 • ASPAN ClinicalGuideline PONV/PDNV

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