Information About Post Operative Nausea and Vomiting (PONV)
February 13, 2012
Post operative nausea and vomiting (PONV) is a serious problem for patients who are undergoing elective surgery. For facial aesthetic surgery PONV can lead to hematoma, delayed healing times, and other complications not the least of which is patient suffering.
Our focused interest in this problem was motivated by the progressive increase of PONV despite liberal use of antiemetics such as Odansetron (Zofran). At the same time we noted the increasing prevalence of antidepressant medications taken by our patients.
Based on our experience and extensive review of the literature we have established a perioperative treatment protocol that is beneficial to your patients and their well being.
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Dr. Nichter |
Dr. Horowitz |
Serotonin Syndrome is a poorly recognized but potentially dangerous condition which in its early stages may include nausea and vomiting (PONV) , hypertension, fever, tachycardia, agitation, restlessness, insomnia, mental status changes, diarrhea, etc. All of these are dangerous in the post operative healing period.
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Serotonin Syndrome occurs when two or more drugs are taken together and cause too much available serotonin. Antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin/norepinephrine reuptake inhibitors (SSNRI), and monamine oxidase inhibitors (MAOI); Migriane Triptan medications including Imitrex, Relpax and others. Pain medications: (especially Tramadol), opioids; antiemetics such as odansetron (Zofran); and even cough medicines with dextromethorphan have been implicated in Serotonin Syndrome.
When your patients, who have been appropriately prescribed these medications, are then given certain pain medications or antiemetics they may develop serotonin syndrome and PONV.
We are attaching a table listing some of the multiple drug classes that have been implicated in this syndrome. In order to keep Serotonin Syndrome from occurring in our patients, we use the protocol attached. This includes the use of Cyproheptadine (periactin) as prophylactic when serotonin medications are used.
We your taking note of these guidelines during the postoperative period and contact us directly if you have any concerns or suggestions.
Thank you for reading.
Best wishes,
Larry S. Nichter, MD, MS, FACS Jed H. Horowitz, MD, FACS
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As soon as you step into our Newport Beach office, our welcoming staff will carefully listen to your concerns and guide you through your treatment journey. The board-certified plastic surgeons at Pacific Center for Plastic Surgery will be happy to discuss your cosmetic goals, review the pros and cons of the treatment you are considering, and create a personalized treatment plan that will deliver the best outcome for you.
To learn more about the innovative treatments offered at Pacific Center for Plastic Surgery in Newport Beach, CA, contact our office by calling (949) 617-1168 or by filling out the consultation request form below.
