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Archive November 2017 XVIII, No. 11

Do Your Anesthetists Have All They Desire?

The 6 drugs and devices anesthesia providers say they can't do without.

Jim Burger

Jim Burger, Senior Editor


anesthesia providers OBJECTS OF DESIRE Are you supplying your anesthesia providers with all they want to do their jobs?

A surgical facility doesn't run well unless the anesthesia providers are happy and content. How do you keep a smile on their faces? By stocking everything they need and want to deliver safe patient care efficiently and economically. This is true regardless of whether you have a different anesthetist every day, as is the case for 43.7% of the 135 OR managers we polled at last month's OR Excellence conference in Las Vegas, Nev., or the same anesthetist every day, as is the staffing model for 37.8% of respondents at ORX. To help you hold up your end of the bargain, we sent an online survey to a select panel of anesthetists that asked them to rank 15 drugs and devices on a 1-to-5 scale, ranging from extremely important to unimportant. Here are the 6 products that scored highest, the 6 no OR should be without, based on 72 responses.

1. Antiemetics
"Most patients would prefer to be in pain than nauseous after surgery," says Mike Donovan, CRNA, reflecting the panel consensus that antiemetics are the most highly valued tool in the anesthesiology armamentarium. "And it's always better to prevent PONV than to treat it."

Of course those spinning heads and inside-out stomachs aren't just miserable for patients, they're expensively inconvenient for facilities, too. And providers say they're employing a variety of weapons and recipes designed to make anesthesia easier to stomach.

Mr. Donovan minimizes PONV by "almost always" administering total intravenous anesthesia and blocking nausea receptors early with 4 mg of ondansetron — often considered the "gold standard" of antiemetics. He typically adds 10 mg of dexamethasone at the end of the case, both for its antiemetic properties and to help with post-op pain control.

The 5 surgeons at the (Savannah) Georgia Institute for Plastic Surgery have "zero tolerance for post-operative nausea and vomiting," says Janice Izlar, CRNA. To prevent it, she pulls out all the stops, starting with 8 mg of ondansetron as soon as patients arrive. All patients having facial procedures also get 8 mg of dexamethasone, unless contraindicated, and those with a history of PONV or motion sickness get 10 mg IV of diphenhydramine during the case. Metoclopramide (5 mg) may also be part of the recipe if patients have a history of GERD or heartburn issues.

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