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Postoperative Nausea and Vomiting
Aka: Postoperative Nausea and Vomiting, Postoperative Nausea and Vomiting Prevention, PONV, Nausea After Surgery, Vomiting After Surgery
- Epidemiology
- Incidence of PONV: 30% (70% in high risk patients)
- Risk factors
- Patient characteristics with higher PONV risk
- Female sex
- History of Motion Sickness
- Prior episode Postoperative Nausea and Vomiting
- Non-smokers
- Postoperative use of opiod Analgesics
- Surgeries with higher PONV risk
- Craniotomy
- Ear, nose and throat surgery
- Major Breast surgery
- Laparoscopy or Laparotomy
- Strabismus surgery
- Anesthetics with higher PONV risk
- Opiod Analgesics
- Nitrous Oxide
- Volatile inhalational Anesthetics
- Prophylaxis: Mild Risk of PONV (1-2 risk factors)
- Dexamethasone (<8 mg single dose)
- Scopolamine
- Serotonin Antagonist (e.g. Ondansetron, Granisetron)
- Ondansetron 4 mg IV given in last 20 min of surgery
- Droperidol (Inapsine)
- Not recommended as first line due to QT Prolongation
- Combination given within 20 min of Anesthesia
- Droperidol 1.25 mg IV and
- Dexamethasone 4 mg IV
- Prophylaxis: Moderate Risk of PONV (3-4 risk factors)
- Serotonin Antagonist with Dexamethasone
- Serotonin Antagonist (e.g. Ondansetron) with Droperidol
- Prophylaxis: High Risk of PONV (>4 risk factors)
- Combination agents in Moderate risk list above and
- Total intravenous Anesthesia with Propofol and
- High concentration oxygen (80%) intraoperatively
- References
- Gan (2002) JAMA 287:1233-6 [PubMed]