Any nausea, retching or vomitting occuring during the first 24-48 hours after surgery in inpatients

Propafol is a useful induction agent in patients known to have PONV

Occurs in 30% of patients (80% in high risk groups)

Risk factors:

• For any surgery, women have 3x greater risk of suffering from PONV than men.
• Gynaecological patients are at particular risk of PONV

Assess cause:

• Infection
• Hypovolaemia
• Pain
• Paralytic ileus
• Drugs

Management

• Non-pharmacological
  • Minimise patient movement
  • Analagesia
  • IV fluids if dehydrated
• Pharmacological
  • 5HT3 receptor antagonist e.g. Ondansetron (4-8mg hourly IV/PO) - first line. Risk of QT prolongation and constipation
  • Histamine (H1) receptor antagonist e.g. Cyclizine (50mg IV/PO/IM). Avoid in severe heart failure
  • Dopamine (D2) receptor antagonist e.g. Prochlorperazine. Risk of extrapyramidal side effects (dystonic reactions)

Other anti-emetics such as corticosteroids or Metoclopramide reserved for specific cases of post-operative nausea and vomiting.