Postoperative nausea and vomiting (PONV)

Learning objectives

Prevent and treat postoperative nausea and vomiting (PONV)

Definition

Postoperative nausea and vomiting (PONV) is the second most common postoperative complication after pain

Scoring

Scoring systems like the Apfel simplified risk score can help raise awareness of PONV and thus increase prophylaxis use. The incidence of PONV, with the presence of 0, 1, 2, 3, and 4 risk factors is approximately 10%, 20%, 40%, 60%, and 80%, respectively.

Risk factor	Points
Female gender	1
Non-smoker	1
History of PONV and/or motion sickness	1
Postoperative opioids	1
Sum of points	0-4

Management

PONV in children

Children have different risk factors for PONV than adults:
- Age ≥3 years
- History of PONV/motion sickness
- Family history of PONV
- Post-pubertal female
- High-risk surgery (strabismus, adenotonsillectomy, otoplasty)
- Surgery <30 minutes
- Volatile anesthetics

Dexamethasone and 5HT antagonists are the antiemetics of choice in children:
- 0 risk factors
  - No prophylaxis or dexamethasone or 5HT3 antagonist
- 1-2 risk factors
  - Dexamethasone and 5HT3 antagonist
- >2 risk factors
  - Dexamethasone and 5HT3 antagonist + consider total intravenous anesthesia

Keep in mind

Do not underestimate the severity of PONV, patients report that it’s a worse experience than pain
PONV can lead to decreased patient satisfaction, aspiration, dehydration, increased length of stay and higher medical costs