Post-op nausea and vomiting is associated with high levels of patient dissatisfaction, longer admissions and therefore higher costs to the medical system. 

Screen with the APFEL score + the other risk factors (younger age, type and length of surgery, anesthetic gases or nitrous exposure)

1+ risk factors? 2 prophylactic anti-emetics. 

3+ risk factors? 3-4 prophylactic anti-emetics. 

For rescue therapy within 6 hours post-op, use a different agent. 

References: 

1.  Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013.

2.  Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-448. doi:10.1213/ANE.0000000000004833

3.  Barash P, Cullen B, Stoelting R. Clinical Anesthesia. 8th ed. Wolters Kluwer

Have questions, comments, corrections, or concerns? Please reach out via email:

[email protected]

All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program

Preoperative Physical Exam:

1. Inspect for factors indicative of difficult BVM, LMA, or Intubation. 

2. Apply the 332-1 Rule (The 1 is the Upper Lip Bite Test which should equal about one pinky finger width of forward jaw protrusion) 

3. Assign a Mallampati Score 

4. Screen for neck mobility 

5. Focused Cardio-Resp exam. Can examine patients veins too.

References:

1.  Sharma S, Patel R, Hashmi MF, Friede R. 3-3-2 Rule. In: StatPearls. StatPearls Publishing; 2020. Accessed June 8, 2020. http://www.ncbi.nlm.nih.gov/books/NBK493235/

2.  Safavi M, Honarmand A, Amoushahi M. Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD. Adv Biomed Res. 2014;3. doi:10.4103/2277-9175.133270

3.  Mahmoodpoor A, Soleimanpour H, Nia KS, et al. Sensitivity of Palm Print, Modified Mallampati Score and 3-3-2 Rule in Prediction of Difficult Intubation. Int J Prev Med. 2013;4(9):1063-1069.

4.  Sullivan P. Ottawa Anesthesia Primer. ECHO BOOK PUBLISHING; 2012.

5.  Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013.

Have questions, comments, corrections, or concerns? Please reach out via email:

[email protected]

All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program

Pre-Op Acronym: YAMPLLE

Y - Why are you here

A- Anesthetic History 

M - Meds and Allergies 

P - Past Medical History / ROS/ ASA

L - Last meal (NPO)

L - Labs and Investigations 

E - Airway and Cardio-Resp Exam. 

References:

1.  Sullivan P. Ottawa Anesthesia Primer. ECHO BOOK PUBLISHING; 2012.

2.  Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013.

3.  Weinstein AS, Sigurdsson MI, Bader AM. Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiology Research and Practice. doi:https://doi.org/10.1155/2018/5912726

4.  Warner ME, Benenfeld SM, Warner MA, Schroeder DR, Maxson PM. Perianesthetic dental injuries: frequency, outcomes, and risk factors. Anesthesiology. 1999;90(5):1302-1305. doi:10.1097/00000542-199905000-00013

Have questions, comments, corrections, or concerns? Please reach out via email:

[email protected] 

All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program