Postoperative nausea and vomiting in adult patients

Objective. - Identifying risk factors and predictive models for Postoperative Nausea and Vomiting (PONV) and developing antiemetic guidelines for its prevention and treatment. Data sources. - Medline(R) (1997-2002) searches, using "postoperative nausea and vomiting" [MESH], complemented by handsearch. Study selection and data extraction. - Published randomised controlled trials, systematic reviews and multivariable analysis of large cohort studies were evaluated. Data synthesis. - Avoiding PONV seems to be one of the highest priority for most patients. Its most important risk factors are volatile anaesthetics and opioids. If these are given to susceptible patients such as female, those with previous history of PONV or motion sickness and non-smoker, this is likely to result in PONV. For patients receiving volatile anaesthesia, simplified risk scores are available to estimate the individual risk of PONV. Patients at high risk for PONV may benefit from a multimodal approach which involves a) lowering the baseline risk (e.g. by total intravenous anaesthesia with propofol) with b) prophylactically given antiemetics such as droperidol, dexamethasone and serotonin antagonists, alone or in combination. In these selected patients, antiemetics are cost effective. Conclusions. - A strategy to prevent and treat PONV should depend on the individuals risk. However, its clinical usefulness and economic implications needs to be validated. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.