PONV

Keyword

PONV Postoperative Nausea and Vomiting

Risk score

Simplified risk score for PONV in adults

Simplified risk score for POV in Children

Prevention

Strategies to Reduce Baseline Risk

• Avoidance of general anesthesia by the use of regional anesthesia
• Use of propofol for induction and maintenance of anesthesia
• Avoidance of nitrous oxide
• Avoidance of volatile anesthetics
• Minimization of intraoperative and postoperative opioids
• Adequate hydration

Treatment

Combinations in children

Timing

• Dexamethasone 4–5 mg IV At induction
• Ondansetron 4 mg IV, 8 mg End of surgery
• Scopolamine Transdermal patch Prior evening or 2 h before surgery

Dose

Antiemetic Doses for Prophylaxis of POV in Children

• Dexamethasone 150 mcg/kg up to 5 mg
• Dimenhydrinate 0.5 mg/kg up to 25 mg
• Dolasetron 350 mcg/kg up to 12.5 mg
• Droperidola 10–15 mcg/kg up to 1.25 mg
• Granisetron 40 mcg/kg up to 0.6 mg
• Ondansetronb 50–100 mcg/kg up to 4 mg
• Tropisetron 0.1 mg/kg up to 2 mg

Further readings

• Gan TJ Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 Jan;118(1):85-113

Reference

• Miller’s Anesthesia, 7th edition, Ch. 86
• Gan TJ Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 Jan;118(1):85-113
• http://ether.stanford.edu/policies/PONV_prophylaxis_guidelines.html
• Apfel CC Who is at risk for postdischarge nausea and vomiting after ambulatory surgery Anesthesiology 2012;117:475–86
• Eberhart LH The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 2004;99:1630–7