| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Department of Anesthesiology, Duke University Medical Center, Durham, NC
Address correspondence and reprint requests to Tong J. Gan, MD, Department of Anesthesiology, Duke University Medical Center, Trent Drive, Durham, NC 27710. Address e-mail to gan00001{at}mc.duke.edu.
Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. This literature shows that female gender post-puberty, nonsmoking status, history of PONV or motion sickness, childhood after infancy and younger adulthood, increasing duration of surgery, and use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids are well established PONV risk factors. Possible risk factors include history of migraine, history of PONV or motion sickness in a child’s parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration, increasing duration of anesthesia, general versus regional anesthesia or sedation, balanced versus total IV anesthesia, and use of longer-acting versus shorter-acting opioids. Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Current risk scoring systems have 
55%–80% accuracy in predicting which patient groups will suffer PONV. Further research examining genetic and under-investigated clinical patient characteristics as potential risk factors, and involving outpatients and children, should improve predictive systems.
This article has been cited by other articles:
|
|
 |
|
  K. Leslie, P. S. Myles, M. T. V. Chan, M. J. Paech, P. Peyton, A. Forbes, D. McKenzie, and and the ENIGMA Trial Group Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia Br. J. Anaesth., August 5, 2008; (2008) aen230v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-C. Chu, J.-P. Shieh, J.-I. Tzeng, J.-Y. Chen, Y. Lee, S.-T. Ho, and J.-J. Wang The Prophylactic Effect of Haloperidol Plus Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopically Assisted Vaginal Hysterectomy Anesth. Analg., May 1, 2008; 106(5): 1402 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. O. Kooij, T. Klok, M. W. Hollmann, and J. E. Kal Decision Support Increases Guideline Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis Anesth. Analg., March 1, 2008; 106(3): 893 - 898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. W. Phillips Jr, D. M. Broussard, W. D. Sumrall III, and S. R. Hart Intraoperative Oxygen Administration Does Not Reduce the Incidence or Severity of Nausea or Vomiting Associated with Neuraxial Anesthesia for Cesarean Delivery Anesth. Analg., October 1, 2007; 105(4): 1113 - 1117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Vetter, D. Carvallo, J. L. Johnson, M. S. Mazurek, and R. G. Presson Jr A Comparison of Single-Dose Caudal Clonidine, Morphine, or Hydromorphone Combined with Ropivacaine in Pediatric Patients Undergoing Ureteral Reimplantation Anesth. Analg., June 1, 2007; 104(6): 1356 - 1363. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. White, R. J. Black, M. Jones, and G. C. Mar Fan Randomized comparison of two anti-emetic strategies in high-risk patients undergoing day-case gynaecological surgery Br. J. Anaesth., April 1, 2007; 98(4): 470 - 476. [Abstract] [Full Text] [PDF]
|
|
|
