P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.
Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO).
Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO.
Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet