Scholz et al developed a predictive model for identifying a patient at risk for postoperative nausea and vomiting (PONV). This can be used to identify patients who may benefit from closer monitoring and prophylactic therapy. The author is from the Universitatskrankenhaus Eppendorf in Hamburg.


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


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