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
- 0 risk factors
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
Suggested reading
- Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting [published correction appears in Anesth Analg. 2020 Nov;131(5):e241]. Anesth Analg. 2020;131(2):411-448.
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