title: Postoperative nausea and vomiting (PONV) : usefulness of the Apfel-score for identification of high risk patients for PONV.
abstract: OBJECTIVE
  Postoperative nausea and vomiting (PONV) still represent an important problem in surgery. Treatment and prevention of PONV requires accurate risk stratification. The simplified Apfel-score includes the four factors female gender, no smoking, postoperative use of opioides and previous PONV or motion-sickness in patients' history. Each of these risk factors is supposed to elevate the PONV-incidence about 20%. The aim of the study was to validate this clinical risk assessment score in patients with high risk for PONV.
  
  
  METHODS
  In a prospective study 93 patients with high risk preoperative score for PONV (Apfel Score III and IV) were analyzed. Patients and nurses were interviewed using a standardized questionnaire at the time of discharge from the post-anesthesia care unit (PACU) as well as 6 hours and 24 hours after admission to the PACU. General anaesthesia was applied as total intravenous anaesthesia (TIVA) with mivacurium, propofol and remifentanil (no nitrous oxide / FI 02 0.5)
  
  
  RESULTS
  In the group with Apfel score III PONV occurred in 59.7% of patients and in the Apfel score group IV in 91.3% of all patients. The incidence of PONV corresponds to the predicted values of 60% for Apfel III and 80% for Apfel IV although the use of TIVA should have reduced the incidence of PONV about 26%. This apparent overestimation could be explained by the frequent questioning of patients and nurses for PONV leading to assessment of very minor symptoms.
  
  
  CONCLUSIONS
  The Apfel-score is a useful and simple tool for stratification of patients with high risk for PONV.
authors.affiliation: Clinic for Anaesthesia, St. Josefs-Hospital Cloppenburg, Krankenhausstrasse 13, 49661 Cloppenburg, Germany. c.weilbach@kh-clp.de
authors.forename: C
authors.initials: C
authors.lastname: Weilbach
authors.forename: N
authors.initials: N
authors.lastname: Rahe-meyer
authors.forename: K
authors.initials: K
authors.lastname: Raymondos
authors.forename: A
authors.initials: A
authors.lastname: Weissig
authors.forename: D
authors.initials: D
authors.lastname: Scheinichen
authors.forename: S
authors.initials: S
authors.lastname: Piepenbrock
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol