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AMBULATORY ANESTHESIOLOGY

Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting

Tong J. Gan, MD^*, Tricia A. Meyer, PharmD, MS, Christian C. Apfel, MD, PhD, Frances Chung, FRCPC^||, Peter J. Davis, MD^¶, Ashraf S. Habib, MB, FRCA^*, Vallire D. Hooper, MSN, RN, CPAN, FAAN^#, Anthony L. Kovac, MD^**, Peter Kranke, MD, PhD, MBA, Paul Myles, MD, Beverly K. Philip, MD, Gregory Samsa, PhD^||||, Daniel I. Sessler, MD^¶¶, James Temo, CRNA, MSN, MBA^##, Martin R. Tramèr, MD, DPhil^***, Craig Vander Kolk, MD, and Mehernoor Watcha, MD

From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy, Scott and White Healthcare System, Department of Anesthesiology, TX A&M University, Temple, Texas; Department of Anesthesia and Perioperative Care, UCSF Medical Center at Mt. Zion, San Francisco, California; ||Department of Anesthesia, University of Toronto, Toronto, Canada; ¶Department of Anesthesiology and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; #School of Nursing, Medical College of Georgia, Augusta, Georgia; **Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; Consultant Anesthesiologist, University of Wuerzburg, Wuerzburg, Germany; Department of Anesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Australia; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; ||||Department of Biometry and Bioinformatics, Duke University Medical Center, Durham, North Carolina; ¶¶Department of OUTCOMES RESEARCH, The Cleveland Clinic, Cleveland, Ohio; ##Duke University Nurse Anesthetist Program, Durham, North Carolina; ***Division of Anesthesiology, Geneva University Hospitals, and Faculty of Medicine, Geneva, Switzerland; Department of Surgery, Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Anesthesiology, Texas Children’s Hospital, Houston, Texas.

Address correspondence and reprint requests to Tong J. Gan, MD, Professor of Anesthesiology, Duke University Medical Center, Durham, NC 27710. Address e-mail to: gan00001{at}mc.duke.edu.

Abstract

The present guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in postoperative nausea and vomiting (PONV) under the auspices of The Society of Ambulatory Anesthesia. The panel critically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. In brief, these guidelines identify risk factors for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic monotherapy and combination therapy regimens for PONV prophylaxis; recommend approaches for treatment of PONV when it occurs; and provide an algorithm for the management of individuals at increased risk for PONV.

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