Prevention and Management of Postoperative Nausea and Vomiting: A Look at Complementary Techniques

Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.     

Perianesthesia challenges in geriatric pain management

The perianesthesia nurse is continually challenged to provide safe and effective pain management. This task becomes more difficult when working with an aging population. Success begins with understanding the challenges in controlling surgical pain and in communicating information regarding pain management prior to the surgery. Sharing of information between the patient, nurse, and other members of the health care team is essential. To provide quality pain care for geriatric patients, who are at greater risk for developing potentially life-threatening side effects of commonly used analgesics, the perianesthesia nurse must be knowledgeable about factors that affect pain management in this population. Common factors affecting pain control in the older adult patient include misconceptions regarding use and effects of analgesics, preexisting cognitive impairment, impaired communication, cultural differences between the nurse and the patient, and physiologic changes in aging that affect how drugs are metabolized.     

Acute postoperative delirium: Definitions, incidence, recognition, and interventions

Emergence excitement or delirium is a common postanesthesia complication. Often, the emergence excitement resolves quickly, and the patient's continued recovery is uneventful. Although the initial period of excitement may be short lived and resolve without long-term sequela, some patients may experience acute postoperative delirium, a phenomenon that is more difficult to assess and of potentially longer duration. Although patients are spending less time in the hospital after surgical procedures, concern over the potential development of acute postoperative delirium remains. Patients at risk present in ambulatory surgery centers and inpatient perianesthesia settings daily. Identification of at-risk patients is crucial to avoiding the development of delirium in the acute postanesthesia care setting. The purpose of this selective review is to define acute postoperative delirium and its incidence, discuss assessment and recognition, describe interventions, and identify future considerations related to this phenomenon.