Prevention of postoperative nausea and vomiting.
OBJECTIVE
To review the literature on the prevention of postoperative nausea and vomiting (PONV) in adults.


METHODS
Literature retrieval was accessed through MEDLINE (1966-December 2006) using the terms postoperative nausea and vomiting, prevention and treatment. Article references were hand-searched for additional relevant articles and abstracts.


METHODS
All studies published in English were evaluated. Those dealing with prevention and treatment of PONV in adults were included in the review.


RESULTS
Evidence suggests that providing prophylactic antiemetic medications in high-risk surgical patients is warranted. 5-HT3 receptor antagonists are widely used, with no one agent being clearly superior. However, studies have shown other types of agents to be more cost-effective.


CONCLUSIONS
The first step in the prevention of PONV is assessment and reduction of risk factors. Although nonpharmacologic therapies may play a role in the treatment of PONV, the mainstay of therapy for PONV is pharmacologic modalities. Patients at moderate to high risk for PONV need prophylactic antiemetic therapy. High-risk patients may require combination therapy with 2 or 3 agents from different antiemetic classes. Rescue antiemetic therapy is needed by patients who actually develop PONV. The agents of choice in such cases should be from antiemetic classes different from those used for prophylaxis of PONV.
Wilhelm
Sheila M
SM
Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA.
Dehoorne-Smith
Michelle L
ML
Kale-Pradhan
Pramodini B
PB
D000932:Antiemetics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control*; D012307:Risk Factors; D012702:Serotonin Antagonists / Q000008:administration & dosage
D000932:Antiemetics; D012702:Serotonin Antagonists