title: Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment.
abstract: BACKGROUND
  The German-language recommendations for the management of postoperative nausea and vomiting (PONV) have been revised by an expert committee. Major aspects of this revision are presented here in the form of an evidence-based review article.
  
  
  METHODS
  The literature was systematically reviewed with the goal of revising the existing recommendations. New evidence-based recommendations for the management of PONV were developed, approved by consensus, and graded according to the scheme of the Scottish Intercollegiate Guidelines Network (SIGN).
  
  
  RESULTS
  The relevant risk factors for PONV include female sex, nonsmoker status, prior history of PONV, motion sickness, use of opioids during and after surgery, use of inhalational anesthetics and nitrous oxide, and the duration of anesthesia. PONV scoring systems provide a rough assessment of risk that can serve as the basis for a risk-adapted approach. Risk-adapted prophylaxis, however, has not been shown to provide any greater benefit than fixed (combination) prophylaxis, and PONV risk scores have inherent limitations; thus, fixed prophylaxis may be advantageous. Whichever of these two approaches to manage PONV is chosen, high-risk patients must be given multimodal prophylaxis, involving both the avoidance of known risk factors and the application of multiple validated and effective antiemetic interventions. PONV should be treated as soon as it arises, to minimize patient discomfort, the risk of medical complications, and the costs involved.
  
  
  CONCLUSIONS
  PONV lowers patient satisfaction but is treatable. The effective, evidence-based measures of preventing and treating it should be implemented in routine practice.
authors.affiliation: Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg GmbH.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rüsch
authors.forename: Leopold H J
authors.initials: LH
authors.lastname: Eberhart
authors.forename: Jan
authors.initials: J
authors.lastname: Wallenborn
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D000465:Algorithms; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D018570:Risk Assessment
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics