Any of you try propofol as a...

[fakin' the funk]

...last resort for PONV? I’ve heard that 1 or 2ccs works wonders, although I’ve never tried it myself.

1-5ml of propofol is a treatment for a great many ailments, like, anxious patient, csection with sketchidural, PONV, epidural in PACU, cardioversion, etc etc

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[vector2]

Ketamine is quite emetogenic ...

I always thought it was relatively neutral in regard to ponv (or maybe beneficial if sparing opioids). From my understanding you have to get to large bolus and cumulative doses before the emesis shows up...

 

[deleted59964]

I always thought it was relatively neutral in regard to ponv (or maybe beneficial if sparing opioids). From my understanding you have to get to large bolus and cumulative doses before the emesis shows up...

I imagine there is a dose response relationship
Given laryngophed was outlining a low emetogenic strategy, I thought I should point out using “lots of ketamine intraop” may be counterproductive

 

[psychbender]

I imagine there is a dose response relationship
Given laryngophed was outlining a low emetogenic strategy, I thought I should point out using “lots of ketamine intraop” may be counterproductive

I guess it depends on the definition of "lots." For procedures like spines, hearts, big ex-laps, etc, I see a large opioid-sparring effect with 0.5-1mg/kg ketamine at it near induction, without increase in nausea or sedation in PACU. I imagine 2-3mg/kg might cause some nausea, as the room spins, melts, and turns into a puddle of elephants.

 

[dhb]

I always thought it was relatively neutral in regard to ponv (or maybe beneficial if sparing opioids). From my understanding you have to get to large bolus and cumulative doses before the emesis shows up...

It's mostly emetogenic during it's most active phase so for 20-30min.

 

[vector2]

I imagine there is a dose response relationship
Given laryngophed was outlining a low emetogenic strategy, I thought I should point out using “lots of ketamine intraop” may be counterproductive

It's mostly emetogenic during it's most active phase so for 20-30min.

I see. I frequently use adjunct dose (<2 mg/kg cumulative ) ketamine for MACs and spines and I've never had PONV issues, but of course the concomitant propofol infusion might just mask any effect.

 

[DM27]

Ketamine has a reported increase in incidence of PONV, but I personally have not noticed it.