Risk for postoperative nausea and vomiting - one or both of the following:
(1) patient with a history of PONV during a previous anesthetic episode
(2) presence of 4 or more of the following:
(2a) history of motion sickness
(2b) nonsmoker
(2c) female with an operation lasting > 2 hours, OR male with an operation lasting > 3 hours
(2d) intrathecal narcotics with general anesthesia or nitrous oxide
(2e) craniotomy, abdominal surgery or ENT surgery
NOTE: Having 4 or 5 out of 5 risk factors should indicate a patient at high risk for PONV. However, a patient with fewer risk factors may benefit from some form of prophylaxis. Golembiewski and O'Brien divided risk into 3 levels:
(1) mild to moderate risk: consider single agent prophylaxis
(2) moderate to high risk: consider combination therapy
(3) very high risk: consider combination therapy or using an alternative method of providing anesthesia
