Guideline for the Management of Postoperative Nausea and Vomiting

Abstract

ObjectiveTo provide recommendations for the management of postoperative nausea and vomiting (PONV), which may affect as many as 30% of patients. Methods and EvidenceMedline, PubMed, and the Cochrane Database were searched for articles published in English from 1995 to 2007. Recognizing that we must work as a team to optimize the care of our patients perioperatively, this guideline was written in partnership with anaesthesiologists. OptionsThe areas of clinical practice considered in formulating this guideline are prevention and prophylaxis, treatment, both medical and alternative, and patient education. OutcomesImplementation of this guideline should optimize the prevention of and prophylaxis against PONV and the prompt treatment of women who suffer from PONV following gynaecologic surgery. Increased awareness of options for management should help minimize the effects of PONV. Benefits, Harms, and CostsPONV results not only in increased patient discomfort and dissatisfaction but also in increased costs related to length of hospital stay. Cost of medications to prevent and treat PONV must be weighed against improved surgical experience for the patient and decreased costs to the system. ValuesRecommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Recommendations1.Physicians should be aware of the risk factors associated with PONV, and the baseline risks should be reduced whenever possible. (III-A)2.When the choice is available, patients should be advised that the risk of PONV decreases when regional rather than general anaesthesia is administered. (III-A)3.The perioperative use of opioids should be minimized. Surgeons should evaluate the risks/benefits of opioid administration in light of the increased risk of PONV. (III-B)4.Prophylactic antiemetics should be administered to patients with moderate or high risk of developing PONV. (II-1A)5.In patients with a high risk of developing PONV, combination antiemetic therapy should be considered. (III-B)6.Acupoint electrical stimulation may be used as an alternative or adjuvant therapy for prevention of PONV. (II-1A)7.For patients with PONV who did not receive prophylaxis or in whom prophylaxis failed, antiemetic treatment should be administered as soon as feasible. (III-A)8.When prophylaxis with one drug has failed, a repeat dose of this drug should not be initiated as a rescue therapy; instead, a drug from a different class of antiemetic drugs should be administered. (III-A)9.As patients who undergo surgery in surgical daycare units may have PONV after they are discharged, they should be given instructions for its management. (III-B)10.Patients at high risk of developing PDNV should be provided with rescue treatment. (III-B)