Apfel & PONV Risk Stratification
What is the purpose of the Apfel scoring system?
To predict a patient's risk of developing PONV within 24 hrs of surgery
Name a side effect of Ondansetron administration.
QT prolongation, serotonin syndrome (when combined with SSRIs or other serotonergic meds)
Note: caution w/ liver dz d/t metab via CYP pathway
Name 2 things that earn a patient a "point" in the Apfel score.
Female gender, nonsmoker, Hx of PONV, postop opioids
Name a contraindication for using a Scopolamine patch for a patient.
Elderly, Narrow-angle glaucoma, impaired mental status
Name a type of anesthetic that would help reduce the risk of PONV.
Regional, opioid-free, TIVA
Important side effect to educate female patients about when administering Aprepitant?
It makes hormonal birth control ineffective for 4 weeks.
Name a surgery type that puts a patient at an increased risk of PONV.
Laparoscopic, gynecologic, cholecystectomy, ENT, trauma
Metoclopramide, Droperidol, Haldol
(all are dopamine receptor blockers)
When scoring a patient using the Apfel score, what % PONV risk is a patient at if they have 3 risk factors?
60% risk of PONV
Reference:
0 risk factors = 10% PONV risk
1 = 20%
2 = 40%
3 = 60%
4 = 80%
Why was Droperidol given a black box warning?
QT prolongation (and possible Torsades)