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Surgery – Post Operative Nausea and Vomiting
One challenging and unpleasant side effect of anesthesia and surgery that can lengthen recovery is post-operative nausea and vomiting (PONV). The type of operation and case mix have an impact on the incidence of PONV. According to estimates, the incidence of PONV without prophylaxis is 30% when General Anesthesia is used with inhalational medicines. In addition to being a side effect of post-operative opioids, PONV is also caused by patient-specific variables, especially a history of PONV
Apfel PONV prediction system
Opioids used after surgery (1 point)
Gender - female (1 point) ♀
Non-smoker (1 point)
Motion sickness/PONV history (1 point)
The baseline risk of PONV can be decreased using a number of effective treatments. Among these are:
Steer clear of nitrous oxide (N2O)
avoiding anesthetics that are volatile
reduction of opioids used during and after surgery
Drink enough water.
Ondansetron, unless contraindicated, is one of two antiemetics with distinct mechanisms of action that should be administered to patients at risk for PONV. Usually administered orally (PO)
Preoperative antiemetics can also be administered intravenously. Ondansetron 8–16 mg PO is one preoperative antiemetic that can be administered as a single dosage. Prochlorperazine 3–6 mg buccal or 5 mg tablets PO; Cyclizine 50 mg PO. With the exception of dexamethasone, which is administered at induction.
Intraoperative antiemetics can be administered intravenously (IV) at the conclusion of the procedure: • Dexamethasone 3.3–6.6 mg IV (at induction). • 4 mg of ondansetron. Cyclizine (20–50 mg). • 625–1250 micrograms of droperidol.
Post-operative antiemetics: routinely evaluate patients to identify PONV.
Regular intravenous antiemetics should be administered to individuals who are vomiting.
Only mild to moderate nausea can be treated with oral and buccal antiemetics, such as ondansetron 4 mg 6 hours per day, cyclizine 50 mg 8 hours per day, and buccal pro-chlorperazine 12 hours per day.
One challenging and unpleasant side effect of anesthesia and surgery that can lengthen recovery is post-operative nausea and vomiting (PONV). The type of operation and case mix have an impact on the incidence of PONV. According to estimates, the incidence of PONV without prophylaxis is 30% when General Anesthesia is used with inhalational medicines. In addition to being a side effect of post-operative opioids, PONV is also caused by patient-specific variables, especially a history of PONV
Apfel PONV prediction system
Opioids used after surgery (1 point)
Gender - female (1 point) ♀
Non-smoker (1 point)
Motion sickness/PONV history (1 point)
The baseline risk of PONV can be decreased using a number of effective treatments. Among these are:
Steer clear of nitrous oxide (N2O)
avoiding anesthetics that are volatile
reduction of opioids used during and after surgery
Drink enough water.
Ondansetron, unless contraindicated, is one of two antiemetics with distinct mechanisms of action that should be administered to patients at risk for PONV. Usually administered orally (PO)
Preoperative antiemetics can also be administered intravenously. Ondansetron 8–16 mg PO is one preoperative antiemetic that can be administered as a single dosage. Prochlorperazine 3–6 mg buccal or 5 mg tablets PO; Cyclizine 50 mg PO. With the exception of dexamethasone, which is administered at induction.
Intraoperative antiemetics can be administered intravenously (IV) at the conclusion of the procedure: • Dexamethasone 3.3–6.6 mg IV (at induction). • 4 mg of ondansetron. Cyclizine (20–50 mg). • 625–1250 micrograms of droperidol.
Post-operative antiemetics: routinely evaluate patients to identify PONV.
Regular intravenous antiemetics should be administered to individuals who are vomiting.
Only mild to moderate nausea can be treated with oral and buccal antiemetics, such as ondansetron 4 mg 6 hours per day, cyclizine 50 mg 8 hours per day, and buccal pro-chlorperazine 12 hours per day.
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