Archive Anesthesia 2016

New Strategies to Prevent Nausea and Vomiting After Surgery

Updated guidelines tell us how to manage patients who are at increased risk for PONV.

Tong Gan, MD, MBA, MHS, FRCA


aromatherapy SMELL OF RELIEF Aromatherapy is just one of the many measures at your disposal to prevent post-operative nausea and vomiting.

How much do patients dread feeling nauseated after they emerge from anesthesia? My research has shown that many patients would be willing to pay $100 out of pocket to avoid experiencing post-operative nausea and vomiting (PONV). The downstream impact of their sick feelings might turn your stomach, too. Vomiting can delay discharge by 20 minutes and the cost of treating PONV is 100 times higher than preemptive therapy with a generic antiemetic. The good news: You can help keep recovering patients feeling fine by following the Society for Ambulatory Anesthesia's recently issued PONV management guidelines, which I helped author ( Here are some highlights from the updated recommendations that you should incorporate into your anesthesia routines.

Identifying likely sufferers
We all know the traditional PONV risk factors: female sex, a history of PONV or motion sickness, non-smokers and post-op opioids. The new guidelines add another risk factor to the list: patients younger than 50. You should determine the need and use of antiemetics on each patient's baseline risk score. Those with 3 or more of the above risk factors are at high risk of PONV, putting the likelihood that they'd experience it at between 60 and 80%. Although patients who undergo surgery in the outpatient setting are at lower risk of PONV, they are at significant risk of experiencing post-discharge nausea and vomiting (PDNV). In addition to the same risk factors for PONV, patients who experience nausea in the PACU are most likely to suffer PDNV.

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