• Vol. 34 No. 2, 196–205
  • 15 March 2005

Multimodal Antiemetic Therapy and Emetic Risk Profiling

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ABSTRACT

Introduction: Postoperative nausea and vomiting (PONV) is a common problem with no simple solution. This review highlights factors that are known to increase the risk of PONV. It examines the various data on pharmacological and non-pharmacological methods that have been used to prevent PONV. Methods: Peer-reviewed journals on the subject were covered. Conclusion: Patient, surgical and anaesthetic factors increase the risk of PONV. While patient and surgical factors are understandably difficult to control, a multimodal approach involving both pharmacological and non-pharmacological interventions has been successfully adopted to reduce the incidence of PONV. Various factors have been identified to categorise patients into different profiles to determine their risk of PONV. Perioperative strategies can then be targeted at these patient groups.


In the last few years, hundreds of papers exploring the issue of postoperative nausea and vomiting (PONV) have been published. It has been estimated that the overall incidence of PONV for all surgeries and patient populations is between 25% and 30%, with severe, intractable PONV estimated to occur in approximately 0.18% of all patients.1 In high-risk groups, PONV occurs in as many as 70% of patients. Despite advances in surgical techniques and the introduction of less emetogenic anaesthetic techniques and drugs, PONV remains an important cause of delayed discharge from the recovery room and decreased patient satisfaction. It is also associated with complications such as tension on suture lines, wound bleeding and dehiscence, increased intracranial pressure, pulmonary aspiration, dehydration and electrolyte imbalance.1

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