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Postoperative nausea and vomiting

Guidelines

Key sources

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)....
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Classification and risk stratification

Risk assessment
As per ASER/SAMBA 2020 guidelines:
Assess the following to identify the patient's risk for PONV:
female gender
B
younger age
B
nonsmoking status
B
history of PONV
B
history of motion sickness
B
general versus regional anesthesia
A
use of volatile anesthetics and nitrous oxide
A
use of postoperative opioids
A
duration of anesthesia
B
type of surgery, such as laparoscopic, bariatric, gynecological surgery, and cholecystectomy
B
Recognize that the following factors have conflicting, disproven, or limited clinical relevance:
ASA physical status
B
menstrual cycle
B
level of anesthesia provider's experience
B
perioperative fasting
A
BMI
B
anxiety
B
nasogastric tube
A
migraine
B
supplemental oxygen
A
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Medical management

Management of PONV
As per AAST/GAIS/SIAARTI/WSES 2022 guidelines:
Administer medications targeting dopaminergic pathways (such as haloperidol, risperidone, metoclopramide, and prochlorperazine) for the management of PONV.
B
Consider adding a second agent (such as ondansetron) for the management of PONV when first-line medications fail to control the symptoms.
B

Preventative measures

Risk reduction: as per ASER/SAMBA 2020 guidelines, Implement the following strategies to reduce the baseline risk for PONV:
use regional anesthesia to avoid general anesthesia
A
use propofol for induction and maintenance of anesthesia
A
avoid using nitrous oxide in surgeries lasting > 1 hour
A
avoid using volatile anesthetics
A
minimize intraoperative
A
and postoperative opioids
A
provide adequate hydration
A
use sugammadex instead of neostigmine for the reversal of neuromuscular blockade.
A

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)