Management of postoperative nausea and vomiting in adults: current controversies

Abstract

Purpose of reviewPostoperative nausea and vomiting (PONV) continue to plague the surgical patient population with an adverse impact on postoperative outcomes. The aim of this review is to critically assess current evidence for PONV management, including studies evaluating baseline risk reduction and antiemetic prophylaxis, to provide a pragmatic approach to prevention and treatment of PONV in routine clinical practice. Recent findingsMultiple recent reviews and guidelines have been published on this topic with some limitations. In the current ERAS era, all patients irrespective of their PONV risk should receive two to three antiemetics for prophylaxis. Patients at a high risk of PONV [i.e. prior history of PONV, history of motion sickness, high opioid requirements after surgery (e.g. inability to use nonopioid analgesic techniques)] should receive three to four antiemetics for prophylaxis. SummaryThis review provides a practical approach to PONV prevention based on recent literature.

Development and assessment of novel machine learning models to predict the probability of postoperative nausea and vomiting for patient-controlled analgesia

“…Although multiple comprehensive guidelines and risk assessment models have been published on the subject, PONV continues to plague the surgical population. The most likely reason is the lack of compliance with nausea and vomiting prevention guidelines 19 . Pysyk et al reported that the incidence of PONV was reduced by annual anesthesiologist performance feedback urging the use of antiemetic medications 20 .…”

Ambulatory surgical patients and sleep apnea

“…All patients irrespective of their PONV risk status should receive antiemetic prophylaxis with a combination of 2 to 3 antiemetics from different classes. 32 A commonly used combination includes dexamethasone (8 to 10 mg) given intravenously after induction of anesthesia. It is preferred due to its long duration of action, analgesic efficacy, as well as potentiation of peripheral nerve blocks.…”

“…It is preferred due to its long duration of action, analgesic efficacy, as well as potentiation of peripheral nerve blocks. 32 Also, a single dose of dexamethasone 8 to 10 mg is safe and does not increase adverse events such as wound infection and healing. In addition, 5-hydroxytryptamine [HT]-3 receptor antagonists such as ondansetron (4 mg, IV) should be given at the end of the surgical procedure.…”

“…In addition, 5-hydroxytryptamine [HT]-3 receptor antagonists such as ondansetron (4 mg, IV) should be given at the end of the surgical procedure. 3,32 For patients at high risk of PONV (eg, history of motion sickness, history of previous PONV, high opioid requirements after surgery) may receive additional antiemetic therapy (eg, transdermal scopolamine or promethazine). Patients experiencing PONV in the postoperative period should receive an antiemetic from a different class than that used in the intraoperative period, for example, low-dose promethazine (6.25 mg, IV) or dimenhydrinate (1 mg/kg, IV).…”

Total intravenous anesthesia for liver resections: anesthetic implications and safety

“…Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of general anesthesia, with an incidence of 30–80% [ 9 ]. In the context of major abdominal surgery, careful attention should be paid to adequate PONV prophylaxis [ 10 ]. A multimodal approach within an enhanced recovery after surgery pathway allows the majority of patients to resume feeding on postoperative day 1 [ 11 ].…”