Postoperative and Postdischarge Nausea and Vomiting After Ambulatory Surgery: An Update

Abstract

Patients undergoing ambulatory surgery have similar, but also different nausea and vomiting stimuli and mechanisms than inpatients. As the emphasis on “street readiness” and discharge home is a unique and important concern for outpatients, various medications, formulations, techniques, risk scores, and guidelines have been introduced to help improve the care of patients having ambulatory surgery. Additional research and data have been obtained regarding the effects of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) on ambulatory anesthesia. More effective antiemetic combination techniques and new long-acting antiemetics have been introduced for PONV and PDNV prevention. Antiemetic drug selection for ambulatory surgery depends on efficacy, cost, adverse effects, and ease of dosing. Safety concerns include adverse events such as the ECG QTc prolongation effects of antiemetics. To help guide antiemetic drug selection, techniques, and therapy, the PONV consensus guidelines were updated in 2014.