Current Concepts in the Management of Postoperative Nausea and Vomiting

Abstract

Postoperative nausea and vomiting (PONV) are still common following surgery. This is not only distressing to the patient, but increases costs. The thorough understanding of the mechanism of nausea and vomiting and a careful assessment of risk factors provide a rationale for appropriate management of PONV. Strategy to reduce baseline risk and the adoption of a multimodal approach will most likely ensure success in the management of PONV.

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…The use of volatile anaesthetic agents, nitrous oxide and parenteral opiates increase the risk significantly. Major abdominal surgery for colorectal disease is associated with a high prevalence of PONV, reaching 70 % in some trials [94]. There are numerous national and international guidelines relating to the use of prophylactic antiemetics, which can reduce PONV by B40 % [95].…”

Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation

“…A baseline risk of PONV (30%) [102][103][104] for standard clinical monitoring and DoA monitoring has been included in the model. The sensitivity of the results to the potential impact of depth of anaesthesia monitoring on the risk of PONV is explored in a scenario analysis using data from a metaanalysis on the effectiveness of BIS on a range of outcomes including PONV by Liu.…”

Hernia in Ambulatory Surgery Centre

“…Although the type of surgery has been identified as a risk factor in numerous reports, its status is still somewhat controversial; the specific procedures implicated as particularly emetogenic sometimes vary among studies [25].…”

“…For patients at moderate to high risk for PONV, regional anesthesia should be considered. If this is not possible or contraindicated and a general anesthesia is used, a multimodal approach that combines pharmacologic and nonpharmacological prophylaxis to minimize risk of PONV should be adopted [25,27].…”