Postoperative nausea and vomiting - Revision history

Spate215 at 19:33, 17 January 2026

2026-01-17T19:33:02Z

Spate215 at 01:36, 17 January 2026

2026-01-17T01:36:57Z

@@ Line 1: / Line 1: @@
-== Risk Factors ==
+'''<big><u>Introductions</u></big>'''
-* history of PONV
+* PONV is a major problem faced in the perioperative setting by anesthesiologists
-* female sex
+* It is known to be one of the major factors, along with pain, that prolongs PACU stays, which can be significantly consequently in the ambulatory setting.
-* young age
+** Each episode of vomiting is thought to prolong the PACU stay by ~ 25 minutes
-* use of volatile anesthetics
+** There is also an increase risk of aspiration
-* use of post-operative opiates
-* non-smoking status

Chris.Rishel: Chris.Rishel moved page Post-operative nausea and vomiting to Postoperative nausea and vomiting without leaving a redirect

2021-10-04T00:14:20Z

Chris.Rishel moved page Post-operative nausea and vomiting to Postoperative nausea and vomiting without leaving a redirect

← Older revision

Revision as of 17:14, 3 October 2021

TymKajstura: new article

2021-10-01T09:36:26Z

new article

New page

== Risk Factors ==
Predictors of post-operative nausea and vomiting include:

* history of PONV
* female sex
* young age
* use of volatile anesthetics
* use of post-operative opiates
* non-smoking status

← Older revision		Revision as of 12:33, 17 January 2026
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	* PONV is a major problem faced in the perioperative setting by anesthesiologists		* PONV is a major problem faced in the perioperative setting by anesthesiologists
	* It is known to be one of the major factors, along with pain, that prolongs PACU stays, which can be significantly ~~consequently~~ in the ambulatory setting.		* It is known to be one of the major factors, along with pain, that prolongs PACU stays, which can be significantly consequential in the ambulatory setting.
	** Each episode of vomiting is thought to prolong the PACU stay by ~ 25 minutes		** Each episode of vomiting is thought to prolong the PACU stay by ~ 25 minutes
	** There is also an increase risk of aspiration		** There is also an increase risk of aspiration and airway compromise


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	**Use of volatile anesthetics (Sevoflurance, Isoflurane, Desflurane) or N2O		**Use of volatile anesthetics (Sevoflurance, Isoflurane, Desflurane) or N2O
	**Opioid use		**Opioid use
			**Etomidate (worse when used w/ opioids)
	*Surgery Related		*Surgery Related
	**Prolonged surgery (therefore, prolonged exposure to anesthetics)		**Prolonged surgery (therefore, prolonged exposure to anesthetics)
	**Laparoscopic surgery, cholecystectomies, and gynecological surgery		**Laparoscopic surgery, cholecystectomies, inner/middle ear cases, and gynecological surgery


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	** 3 = 60%		** 3 = 60%
	** 4 = 80%		** 4 = 80%


	'''<big><u>Prophylaxis</u></big>'''		'''<big><u>Prophylaxis</u></big>'''

	* Regional nerve blocks can be used to reduce the amount of ~~perioperative~~ opioids required		* Regional nerve blocks can be used to reduce the amount of peri-operative opioids required
	* If patient requires general anesthesia, you can substitute volatile anesthetic with a propofol-based TIVA approach		* If patient requires general anesthesia, you can substitute volatile anesthetic with a propofol-based TIVA approach
	* N2O is a common culprit of PONV, and therefore should be avoided. If it needs to be used, less than 1 hour of exposure is preferred		* N2O is a common culprit of PONV, and therefore should be avoided. If it needs to be used, less than 1 hour of exposure is preferred
	* Appropriately volume resuscitate the patient to keep them well hydrate		* Appropriately volume resuscitate the patient to keep them well hydrate
			**Can also be achieved by preoperative administration of carbohydrate drinks
	* If the patient has 1-2 risk factors, administer 2 anti-emetic agents		* If the patient has 1-2 risk factors, administer 2 anti-emetic agents
	* If the patient has 2+ risk factors, consider administered 3-4 anti-emetic agents		* If the patient has 2+ risk factors, consider administered 3-4 anti-emetic agents


	'''<big><u>Treatment</u></big>'''		'''<big><u>Treatment</u></big>'''
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	* There are many medications that can be used to treat PONV. The main receptors that they work at to prevent/treat nausea and vomiting include: M1 (muscarinic), D2 (Dopamine), H1 (Histamine), 5HT3 (Serotonin), and NK1 (Substance P)		* There are many medications that can be used to treat PONV. The main receptors that they work at to prevent/treat nausea and vomiting include: M1 (muscarinic), D2 (Dopamine), H1 (Histamine), 5HT3 (Serotonin), and NK1 (Substance P)
	* These receptors are located at the area postrema of the brain		* These receptors are located at the area postrema of the brain


	'''<u><big>Medication Classes</big></u>'''		'''<u><big>Medication Classes</big></u>'''
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	** MoA: Unclear, believed to inhibit prostaglandins peripherally		** MoA: Unclear, believed to inhibit prostaglandins peripherally
	** Side Effects: Insomnia, increased energy, mood changes		** Side Effects: Insomnia, increased energy, mood changes
			**Be weary of administering in patient's with uncontrolled diabetes or sepsis
	* NK1 Receptor Antagonists		* NK1 Receptor Antagonists
	** Ex (Dose): Aprepitant (40 mg PO)		** Ex (Dose): Aprepitant (40 mg PO)
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	** Ex (Dose): Scopolamine (patch administered 2-4 hours pre op), Promethazine (6.25 mg)		** Ex (Dose): Scopolamine (patch administered 2-4 hours pre op), Promethazine (6.25 mg)
	** MoA: Antagonizes muscarinic receptors of the vestibular apparatus and the nucleus of the tractus solitarus		** MoA: Antagonizes muscarinic receptors of the vestibular apparatus and the nucleus of the tractus solitarus
	** Side Effects: Sedation, dry mouth, visual disturbance		** Side Effects: Sedation, dry mouth, visual disturbance. Can precipitate acute angle closure glaucoma in susceptible patients
	* Phenothiazines		* Phenothiazines
	** Ex (Dose): Promethazine (6.25 mg), Prochlorperazine (5-10 mg)		** Ex (Dose): Promethazine (6.25 mg), Prochlorperazine (5-10 mg)
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	** Ex (Dose): Droperidol (0.625 mg IV), Haloperidol (0.5-2 mg IM/IV)		** Ex (Dose): Droperidol (0.625 mg IV), Haloperidol (0.5-2 mg IM/IV)
	** MoA: Antagonize central dopaminergic receptors		** MoA: Antagonize central dopaminergic receptors
	** Side Effects: Sedation, agitation, extrapyramidal effects, hypotension		** Side Effects: Sedation, agitation, extrapyramidal effects, hypotension, QT prolongation/Torsades