Adjuncts to Anesthesia

Recommendations from the Society of Ambulatory Anesthesia (SAMBA):

1. Identify patients at risk for PONV.

2. Use management strategies to reduce PONV risk.

3. Use one to two prophylactic measures in adults at moderate PONV risk.

4. Use multiple interventions in patients at high PONV risk.

5. Administer prophylactic antiemetic therapy to children at high risk using combination therapy.

6. Provide antiemetic therapy to patients with PONV who did not receive prophylactic therapy or in whom prophylaxis failed. Therapy should be with a drug from a different class than that which failed to provide prophylaxis.

Other Adjuvants

Ketorolac: A parenterally administered nonsteroidal antiinflammatory drug that provides analgesia by inhibiting prostaglandin synthesis. It is used for short-term management of pain (<5 days). It does not cause respiratory depression, sedation, or nausea and vomiting.

Side effects: Inhibits platelet aggregation and prolongs bleeding time. Long-term use may cause renal toxicity or GI tract ulceration with bleeding and perforation. It should be avoided in patients with renal failure. It is contraindicated in patients allergic to aspirin or NSAIDs.

Clonidine: An imidazoline derivative with predominantly α2 adrenergic agonist activity. It is an antihypertensive agent but also possesses analgesic properties and has local anesthetic effects. It may be used as an adjunct for epidural, caudal, and peripheral nerve block anesthesia and analgesia.

Side effects: Sedation, dizziness, bradycardia, and dry mouth are common side effects. Less commonly, bradycardia, orthostatic hypotension, nausea, and diarrhea may occur. Abrupt discontinuation following long-term administration (>1 month) can lead to withdrawal symptoms characterized by rebound hypertension, agitation, and sympathetic overactivity.

Dexmedetomidine: A parenteral selective α2 agonist with sedative properties. It appears to be more selective for the α2 receptor than clonidine. It causes dose-dependent sedation, anxiolysis, and some analgesia, and blunts the sympathetic response to surgery and other stress. It does not significantly depress respiratory drive.

Side effects: Bradycardia, heart block, and hypotension. It may also cause nausea.

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