Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and intraoperatively (Peri2)
CPT4 code
Name of the Procedure:
Administration of Perioperative Dual-Class Anti-Emetic Prophylaxis
Summary
This procedure involves giving a patient at least two different types of anti-nausea medications both before and during surgery to prevent postoperative nausea and vomiting (PONV).
Purpose
It addresses the risk of PONV, a common and uncomfortable side effect of anesthesia and surgery. The goal is to significantly reduce or eliminate the occurrence of nausea and vomiting after the operation, leading to a smoother and more comfortable recovery for the patient.
Indications
- Previous history of PONV or motion sickness
- Non-smokers
- Female gender
- Use of postoperative opioids
- Types of surgery with high PONV risk (e.g., gynecological, laparoscopic, and ENT surgeries)
Preparation
- Patient may be instructed to fast before surgery as per standard surgical protocols
- Review of current medications and possibly stopping certain drugs that may increase PONV risk
- Preoperative assessment to determine the most appropriate anti-emetic agents based on medical history and surgery type
Procedure Description
- Preoperative Phase:
- Select two anti-emetic agents from different pharmacologic classes (e.g., a serotonin receptor antagonist like ondansetron and a corticosteroid like dexamethasone).
- Administer the first anti-emetic intravenously or orally as prescribed.
- Intraoperative Phase:
- Administer the second anti-emetic during anesthesia induction or at an appropriate time during the surgery, as guided by the anesthesia provider.
Tools: IV administration sets, medications (ondansetron, dexamethasone, etc.)
Anesthesia: The procedure itself is part of the broader surgical/anesthesia plan.
Duration
The administration of the medications takes a few minutes, but the procedure duration corresponds to the length of the surgery, ranging from 30 minutes to several hours.
Setting
Hospital or surgical center operating room
Personnel
- Anesthesiologist or nurse anesthetist
- Surgical team (surgeons, surgical nurses)
Risks and Complications
Common:
- Mild dizziness
- Headache
- Injection site reactions
Rare:
- Allergic reactions
- Cardiovascular effects (e.g., arrhythmias in predisposed individuals)
Benefits
- Effective prevention of PONV
- Improved comfort and quicker recovery post-surgery
- Potentially shorter hospital stay and quicker return to normal activities
Recovery
- Monitoring for immediate side effects in the post-anesthesia care unit (PACU)
- Normal diet and activities resumed gradually, as instructed
- Follow-up to assess any delayed side effects or PONV
Alternatives
- Single anti-emetic agent therapy (less effective for high-risk patients)
Non-pharmacologic interventions (e.g., acupressure)
Pros of Dual-Class Therapy:
Higher efficacy in preventing PONV for high-risk patients
Cons:
- Slightly increased complexity and cost
Patient Experience
Patients generally won't feel the administration of anti-emetics specifically but will likely experience reduced nausea and vomiting post-surgery. Mild side effects are possible but tend to be manageable. Pain and discomfort related to the surgery itself are addressed with appropriate pain management strategies.