Table of contents
Postoperative nausea and vomiting
The following summarized guidelines for the evaluation and management of postoperative nausea and vomiting are prepared by our editorial team based on guidelines from the Global Alliance for Infection in Surgery (GAIS/WSES/AAST/SIAARTI 2022), the Society for Ambulatory Anesthesia (SAMBA/ASER 2020), the British Thoracic Society (BTS 2017), and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2008).
1.Classification and risk stratification
Assess the following to identify the patient's risk for PONV:
history of PONV
history of motion sickness
general versus regional anesthesia
use of volatile anesthetics and nitrous oxide
use of postoperative opioids
duration of anesthesia
type of surgery, such as laparoscopic, bariatric, gynecological surgery, and cholecystectomy.
Recognize that the following factors have conflicting, disproven, or limited clinical relevance:
ASA physical status
level of anesthesia provider's experience
Management of postoperative nausea and vomiting
As per WSES 2022 guidelines:
Administer medications targeting dopaminergic pathways (such as haloperidol, risperidone, metoclopramide, and prochlorperazine) for the management of PONV.
Consider adding a second agent (such as ondansetron) for the management of PONV when first-line medications fail to control the symptoms.
Risk reduction: as per ASER 2020 guidelines, implement the following strategies to reduce the baseline risk for PONV:
use regional anesthesia to avoid general anesthesia
use propofol for induction and maintenance of anesthesia
avoid using nitrous oxide in surgeries lasting > 1 hour
avoid using volatile anesthetics
minimize intraoperative and postoperative opioids
provide adequate hydration
use sugammadex instead of neostigmine for the reversal of neuromuscular blockade.
More topics in this section
Prevention of PONV (indications)
Prevention of PONV (choice of agent)
Prevention of PONV (acupoint stimulation)
Prevention of PONV (oxygen supplementation)