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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

  1. 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.
  2. 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.

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