I. Epidemiology

  1. Incidence of PONV: 30% (70% in high risk patients)

II. Risk factors

  1. Patient characteristics with higher PONV risk
    1. Female sex
    2. History of Motion Sickness
    3. Prior episode Postoperative Nausea and Vomiting
    4. Non-smokers
    5. Postoperative use of opiod Analgesics
  2. Surgeries with higher PONV risk
    1. Craniotomy
    2. Ear, nose and throat surgery
    3. Major Breast surgery
    4. Laparoscopy or Laparotomy
    5. Strabismus surgery
  3. Anesthetics with higher PONV risk
    1. Opiod Analgesics
    2. Nitrous oxide
    3. Volatile inhalational anesthetics

III. Prophylaxis: Mild Risk of PONV (1-2 risk factors)

  1. Dexamethasone (<8 mg single dose)
  2. Scopolamine
  3. Serotonin Antagonist (e.g. Ondansetron, Granisetron)
    1. Ondansetron 4 mg IV given in last 20 min of surgery
  4. Droperidol (Inapsine)
    1. Not recommended as first line due to QT Prolongation
    2. Combination given within 20 min of anesthesia
      1. Droperidol 1.25 mg IV and
      2. Dexamethasone 4 mg IV

IV. Prophylaxis: Moderate Risk of PONV (3-4 risk factors)

  1. Serotonin Antagonist with Dexamethasone
  2. Serotonin Antagonist (e.g. Ondansetron) with Droperidol

V. Prophylaxis: High Risk of PONV (>4 risk factors)

  1. Combination agents in Moderate risk list above and
  2. Total intravenous anesthesia with Propofol and
  3. High concentration oxygen (80%) intraoperatively

VI. References

Images: Related links to external sites (from Google)

Ontology: Postoperative Nausea and Vomiting (C0520909)

Definition (MSH) Emesis and queasiness occurring after anesthesia.
Concepts Sign or Symptom (T184)
MSH D020250
SnomedCT 1488000
Swedish Postoperativ illamående och kräkning
English POSTOP NAUSEA VOMITING, NAUSEA VOMITING POSTOP, PONV - Postop nausea+vomiting, Postoperative nausea+vomiting, Nausea and Vomiting, Postoperative, Postoperative Nausea and Vomiting, PONV, Postoperative Nausea and Vomiting [Disease/Finding], ponv, postoperative nausea and vomiting (PONV), Postoperative nausea and vomiting, PONV - Postoperative nausea and vomiting, Postoperative nausea and vomiting (disorder)
Czech pooperační nevolnost a zvracení
Finnish Leikkauksenjälkeinen pahoinvointi ja oksentaminen
Russian POSLEOPERATSIONNAIA TOSHNOTA I RVOTA, RVOTA POSLEOPERATSIONNAIA, TOSHNOTA I RVOTA POSLEOPERATSIONNAIA, ПОСЛЕОПЕРАЦИОННАЯ ТОШНОТА И РВОТА, РВОТА ПОСЛЕОПЕРАЦИОННАЯ, ТОШНОТА И РВОТА ПОСЛЕОПЕРАЦИОННАЯ
Japanese 悪心・嘔吐-手術後, 手術後悪心, 手術後嘔吐, 手術後悪心と手術後嘔吐, 術後悪心, 悪心・嘔吐-術後, 嘔吐-術後, 悪心-手術後, 手術後悪心・嘔吐, 悪心-術後, 術後嘔吐, 嘔吐-手術後, 術後悪心・嘔吐
Spanish Náuseas y Vómitos Postoperatorios, Náusea y Vómito Postquirúrgico, Nauseas y Vomitos Postoperatorios, Nausea y Vomito Postquirurgico, Náuseas y Vómitos Postquirúrgicos, Nauseas y Vomitos Postquirurgicos, náuseas y vómitos posoperatorios, náuseas y vómitos posquirúrgicos, náuseas y vómitos postoperatorios (trastorno), náuseas y vómitos postoperatorios, NVPO, Náusea y Vómito Postoperatorio, Nausea y Vomito Postoperatorio
Italian PONV, Nausea e vomito postoperatorio
Polish PONV, Nudności i wymioty pooperacyjne
French Vomissements et nausées postopératoires, Vomissements et nausées post-opératoires
German Postoperative Übelkeit und Erbrechen, Übelkeit und Erbrechen, postoperatives
Dutch Misselijkheid en braken, postoperatieve, PONV, Postoperatieve misselijkheid en braken
Portuguese PONV, Náusea e Vômito Pós-Operatório