Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Abstract

The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy

“…No differences were noted between methylprednisolone and dexamethasone in postoperative pain, oral intake and alimentation scores but with a follow-up limited to the first 24 postoperative hours [20]. The dose of dexamethasone used in our study is in agreement with guidelines recently reassessed [21] for PONV prophylaxis. A prospective study found a 57.5% reduction in severe pain on POD2 with a single dose of dexamethasone at 0.15 mg/kg compared to placebo, with a prolonged decrease of PONV during the first two postoperative days [22].…”

The effects of intravenous fosaprepitant and ondansetron in the prevention of postoperative nausea and vomiting in patients who underwent lower limb surgery: a prospective, randomized, double-blind study

“…In addition, antiemetics are more efficacious when administered toward the end of surgery rather than at anesthesia induction. Furthermore, consensus guidelines for PONV recommend multimodal prophylaxis to prevent PONV in high-risk patients [23]; further studies are therefore required to evaluate the potential usefulness of this drug in combinations with other antiemetics.…”

Hernia in Ambulatory Surgery Centre

“…Incidence of PONV can be as high as 80% in high-risk patients with incidence of vomiting about 30% and nausea about 50% [24]. PONV can result in extended postanesthesia care unit (PACU) stay with unforeseen hospital admission so we see that PONV results in a significant increase in overall care costs.…”