The British journal of theatre nursing : NATNews : the official journal of the National Association of Theatre Nurses最新文献

The immediate post-anaesthetic period is a particularly vulnerable time for patients, fraught with risk from dangerous complications. Recovery staff play a vital role in the ongoing, continuous assessment of patients at this period in their operative experience, and must be skilled in detecting and preventing the onset of serious, sometimes life-threatening events. Vigilant recovery care can assist in ensuring ward staff receive an awake, stable and comfortable patient who has been cared for in an atmosphere where safety and comfort are of paramount concern.

Objectives: To determine the efficacy and safety of ondansetron for the prevention and treatment of postoperative nausea and vomiting (PONV) in adults.

Design: Systematic review of published double-blind randomised controlled trials.

Data sources: Twenty seven trials from 1990 to July 1998 retrieved from a systematic literature search (Medline, Cinahl, Embase, Cochrane Library, reference lists, hand searching of anaesthetic journals, & provided manufacturer information); restricted to English language.

Main outcome measures: Estimation of efficacy (incidence of complete absence of nausea or other outcome measure as defined by the authors) at 24 hours.

Results: Seven double-blind randomised controlled trials with 1,623 patients studied intravenous ondansetron 1 mg, 4 mg, or 8 mg for the treatment of postoperative nausea and vomiting (PONV). Four mg, compared with metoclopramide 10 mg, produced higher patient satisfaction scores and an increased incidence of freedom from nausea at 24 hours. Further studies are required to compare the safety, efficacy and dose response with other anti-emetics at 24 hours. Twenty double-blind randomised controlled trials with 4,364 patients studied intravenous and oral administration of ondansetron 1 mg, 4 mg, and 8 mg for the prevention of postoperative nausea and vomiting. There appears to be no significant difference between droperidol (0.625 mg, 1 mg or 1.25 mg) i.v. and ondansetron 4 mg in efficacy and incidence of side effects. Compared with metoclopramide, ondansetron produced less nausea but the incidence of vomiting was the same at 24 hours.

Conclusions: Further PONV could be prevented with ondansetron 4 mg compared with placebo and metoclopramide 10 mg. Further studies are required to compare ondansetron with other anti-emetics for the treatment of PONV. For prophylaxis of PONV ondansetron 4 mg appears to be equal to low dose droperidol in efficacy and the incidence of side effects, and superior to metoclopramide. Ondansetron should perhaps be limited to second line treatment in view of patient satisfaction, efficacy and cost when compared with droperidol.

Organ harvesting is part of the practice of many perioperative nurses in general hospitals. It is difficult to treat as just another case because the outcome is so different to other surgery, and brings a much more intense level of emotional involvement. Add to this the fact that organ harvesting often takes place outside 'normal' working hours, and that the staff providing facilities for donation are left with the body and the mess, it is evident that both the issue and the perioperative nurse's part in this practice require some special attention. This is the first of three excellent articles by Janet Bothamley, based on her wide ranging review of the literature covering theatre nurses' perceptions of organ retrieval. Consent and patients' rights, and brain stem death, will be dealt with in the subsequent articles.