[Risk assessment, prophylaxis and treatment for postoperative nausea and vomiting].
The incidence of postoperative nausea and vomiting in the general population has been estimated to have remained constant at around 20% to 30% in recent years, but it can reach 80% in high-risk patients. A wide range of risk factors related to patient variables, anesthetic technique, or surgery have been described. However, risk can be classified by taking only 4 factors into consideration: female gender, nonsmoker, a history of motion sickness or postoperative vomiting, and use of opioids for postoperative analgesia. Antiemetic prophylaxis is not recommended for patients at low-risk (only 1 risk factor or none). Considering prophylaxis is recommended for patients at moderate risk (2 risk factors). For patients at high risk (3 or 4 risk factors), prophylaxis should be provided with 4 mg of intravenous ondansetron 30 minutes before ending surgery, 4 mg of intravenous dexamethasone at anesthetic induction, or both. Besides medical prophylaxis, strategies for lowering underlying risk are recommended: use regional anesthesia whenever possible, use total intravenous anesthesia with propofol if regional anesthesia is impossible, keep opioid and neostigmine use to a minimum, and try to maintain adequate hydration during surgery. Once preventive measures are taken, therapeutic options are limited and the management of postoperative nausea and vomiting, once established, is difficult.
Bel Marcoval
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Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic i Provincial, Universidad de Barcelona. ibelmarc@hotmail.com
Gambús Cerrillo
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P
D000465:Algorithms; D000932:Antiemetics / Q000627:therapeutic use*; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment
D000932:Antiemetics