Prophylaxis and management of postoperative nausea and vomiting in enhanced recovery protocols: Expert Opinion statement from the American Society for Enhanced Recovery (ASER)
© Gupta and Soto. 2016
Received: 16 January 2016
Accepted: 10 February 2016
Published: 2 March 2016
International experience and evidence-based practices have shown that reduction in variability through use of protocolized perioperative care improves surgical outcomes and reduces costs to patients and healthcare systems. In this series of Expert Opinions, we provide consensus recommendations for the various components of perioperative care to aid with the development of enhanced recovery after surgery protocols.
KeywordsNausea Vomiting Prophylaxis Expert Opinion
Early ambulation, early feeding, and early return of bowel function are linked with quicker recovery, earlier discharge, and improved satisfaction. Postoperative nausea and vomiting (PONV) is a common complication following abdominal surgical procedures with patient (young age, female sex, history of motion sickness), anesthetic (use of opioids and volatile anesthetics), and surgical (length of case, use of insufflation, manipulation of the bowel) factors contributing to its incidence and severity. Nausea and vomiting should be viewed as existing on a continuum, and sequelae and patient discomfort vary based on patient experience, surgical procedure, and recovery profile. Guidelines for its avoidance and treatment are based on evidence-based literature, expert opinion, and professional association recommendations [ASPAN’S evidence-based clinical practice opinion for the prevention and/or management of PONV/PDNV. J Perianesth Nurs 2006 [Gan et al. 2007] Gan et al. 2014. Gan et al. 2003.
- 1.Modifiable risk factors
Use of volatile anesthetics
Intraoperative use of opioids
Smoking (tobacco use decreases PONV risk)
- 2.Non-modifiable risk factors Apfel et al. 2012a
Young age (<50)
History of PONV
Surgical location (abdominal/pelvic, ENT, breast)
Surgical technique (laparoscopic)
Serotonin antagonists (e.g., ondansetron)
Dopamine antagonists (e.g., droperidol, metoclopramide)
Anticholinergics (e.g., scopolamine)
Antihistamines (e.g., diphenhydramine)
Steroids (e.g., dexamethasone)
Others (e.g., trimethobenzamide)
ASER Expert Opinion
All patients should receive PONV prophylaxis during the perioperative period. The numbers of medications used for treatment and prophylaxis should be determined by the number of modifiable and non-modifiable risk factors. Medications used should represent different mechanisms of action in an attempt to achieve multimodal benefit Tramèr 2001.
American Society for Enhanced Recovery
ear, nose, and throat
postoperative nausea and vomiting
The authors wish to make no acknowledgements at this time.
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