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Biomedical subjects

Julie Golembiewski

Publications and source records attributed to Julie Golembiewski.

13 recordsLinked to original sources
PubMed2006

Pharmacological prophylaxis and management of adult postoperative/postdischarge nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.

Adult↗
PubMed2005

Prevention and treatment of postoperative nausea and vomiting.

PURPOSE: The physiology, risk factors, and prevention and treatment of postoperative nausea and vomiting (PONV) are discussed. SUMMARY: Factors to consider when determining a patient's risk for PONV include sex, history of PONV, history of motion sickness, smoking status, duration of anesthesia, use of opioids, and type of surgery. Receptors that, when activated, can cause nausea or vomiting or both include dopamine type 2, serotonin type 3, histamine type 1, and muscarinic cholinergic type 1 receptors. Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone. In high-risk patients, combining two or more antiemetics with different mechanisms of action has been shown to be more effective than using a single agent. In addition to administering a prophylactic antiemetic, it is important to reduce the patient's risk by considering regional anesthesia, considering inducing and maintaining general anesthesia with propofol, ensuring good intravenous hydration, avoiding hypotension, and providing effective analgesia. If PONV occurs in the immediate postoperative period, it is best treated with an antiemetic agent from a pharmacologic class different from that of the prophylactic agent. CONCLUSION: Prophylactic antiemetic therapy for PONV is effective, but combinations of agents may be necessary for high-risk patients. Nonpharmacologic strategies are also important.

Antiemetics↗
PubMed2004

Considerations in selecting an inhaled anesthetic agent: case studies.

PURPOSE: Product and patient-specific factors that may influence the selection of an inhaled anesthetic agent are discussed in four case studies. SUMMARY: The cardiovascular, respiratory, hepatic, and renal effects of various inhaled anesthetic agents vary and may be important in selecting an agent for patients with impairment of these systems. The extent to which anesthetics are metabolized and the risk of hepatotoxicity also vary. Halothane is associated with a relatively high risk for arrhythmias and hepatotoxicity. It also has a high solubility in tissues and is associated with a slow onset and termination of effect and recovery. Pharmacokinetic and pharmacodynamic differences among anesthetics may be important considerations, depending on the surgical setting, anticipated duration of surgery, whether endotracheal intubation is used, and other patient-specific factors such as body weight and age. The duration of surgery is an important consideration for most patients because differences between inhaled anesthetics in offset of effect vary with the duration of the procedure. Desflurane or sevoflurane may be preferred for obese patients because of a faster recovery and greater respiratory safety compared with isoflurane. Sevoflurane is preferred for pediatric patients undergoing induction by inhalation because of its low propensity to cause respiratory irritation. CONCLUSION: There are many product- and patient-specific factors that pharmacists must take into account when selecting an inhaled anesthetic agent. It is important to consider all of these factors when developing the pre- and post-anesthesia plan.

Adult↗
PubMed2004

Medication use in the elderly patient: focus on the perioperative/perianesthesia setting.

As the population ages, the use of multiple medications also increases. Polypharmacy (taking multiple drugs at a time) presents concerns to the perianesthesia nurse who is caring for the geriatric patient. The pharmacokinetics and pharmacodynamics of drugs are often altered in older adult patients. Adverse drug reactions and drug interactions occur more often in geriatric patients than in younger patients. For these reasons, the benefits and risks of multiple medications and the administration of certain types of drugs must be carefully considered in the elderly patient. The selection of any medication should be individually based on the benefits and risks. Adverse drug reactions play a significant role in hospitalization for the general population, and the elderly are more susceptible to these. These drug reactions often contribute to significant morbidity as well as mortality. Medications need to be considered carefully in the older adult patient, but perhaps more so in the perioperative/perianesthesia period. Drug interactions are diverse. The type of anesthesia may influence the patient's outcome, depending on the medications the patient is currently taking. The patient's response to the stress of surgery is also affected by individual medical conditions as well as medications the patient is currently receiving Polypharmacy, inappropriate medications, adverse drug reactions, drug-disease issues, and drug interactions in the geriatric population are concerns in the perioperative/perianesthesia setting.

Age Factors↗