scott@vtx-cpd.com

Hello Loren.

This is a brilliant question. I do not think people are using it routinely for every soft tissue surgery, but I would use it in any case if there is any evidence of vomiting/nausea. Even if the patient is not vomiting, but is in any way anorexic, I will use it. There is indeed the ongoing discussion regarding the use of maropitant a visceral analgesic, and I will often use it in cases like pancreatitis. It has also been looked at in cases on respiratory disease:

https://pubmed.ncbi.nlm.nih.gov/26995558/

Overall, maropitant is a safe drug, so I would err on the side of using it rather than not!

I have asked Jon and Felipe for their thoughts too!

Scott 🙂

Replying to Katy Jones 24/10/2023 - 22:36

Hello Katy.

Hope you are well. I am glad you are enjoying the course. This is a great question. I think that either fluid is probably fine in this situation, most of them just need fluid volume! The body/kidneys seem to sort the rest out!

Although no studies yet guide specific fluid choices, 0.9% NaCl (saline) is sometimes recommended because it contains more Na and Cl and less K than other crystalloid fluids. Concerns can be raised regarding the relatively low pH of saline, but the clinical significance of hyponatremia and hyperkalaemia far outweighs risk of iatrogenic acidosis. Any acidosis associated with HA is usually mild and corrects within 12-24 hours of IV saline administration.

Hartman’s is indeed alkalinising and the potassium is not going to have a massive effect, especially once volume is restored.

I agree with Laura, I normally go with Hartman’s. I am not smart enough to make up fancy fluids!

Hope that helps.

Scott 🙂