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Non-Pharmacological Options
P6 Acupuncture Stimulation
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Efficacy = prophylactic antiemetics such as ondansetron, droperidol, metoclopramide
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Timing of trans-cutaneous acupoint electrical stimulation does not impact PONV, with similar reductions being achieved with stimulation initiated before or after induction of anesthesia
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Neuromuscular stimulation over the median nerve also reduces the incidence of PONV in the early postoperative period, particularly when tetanic stimulation is used
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Stimulation of L14 and ST36 acupoints may also be effective
Adequate IV Hydration
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10-30 ml/kg effective to reduce risk of PONV
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No difference between crystalloid vs colloids
Carbohydrate loading
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Inconsistent results but overall no impact on PONV
Aromatherapy
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Reduced need for rescue antiemetics (low evidence) but not incidence or severity of nausea
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Isopropyl alcohol somewhat effective; peppermint not effective
Chewing gum
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Early evidence that might be helpful
Adapted from Anesth Analg. August 2020 - Volume 131 - Issue 2 - p 411-448
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