A simplified algorithm for prevention of postoperative nausea and vomiting is effective: a re-evaluation audit

Editor—Postoperative nausea and vomiting (PONV) remain amongst the most frequent adverse events after anaesthesia. PONV has been extensively studied, with a comprehensive body of research describing causes, risk prediction, prophylaxis, and treatment, 1 Gan T.J. Belani K.G. Bergese S. et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020; 131: 411-448 Crossref PubMed Scopus (307) Google Scholar which has resulted in development of risk scores, guidelines, and treatment protocols. 1 Gan T.J. Belani K.G. Bergese S. et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020; 131: 411-448 Crossref PubMed Scopus (307) Google Scholar , 2 Gan T.J. Meyer T. Apfel C.C. et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003; 97: 62-71 Crossref PubMed Scopus (783) Google Scholar , 3 Gan T.J. Meyer T. Apfel C.C. et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007; 105: 1615-1628 Crossref PubMed Scopus (524) Google Scholar , 4 Gan T.J. Diemunsch P. Habib A.S. et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118: 85-113 Crossref PubMed Scopus (969) Google Scholar Unfortunately, implementation of PONV guidelines into routine clinical practice continues to be poor. 5 Eberhart L.H.J. Morin A.M. Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: con – ‘life is really simple, but we insist on making it complicated’. Eur J Anaesthesiol. 2011; 28: 155-159 Crossref PubMed Scopus (45) Google Scholar Implementation based on a valid assessment of individual risk for PONV is difficult in a busy clinical environment, and is associated with low adherence to PONV management algorithms. 5 Eberhart L.H.J. Morin A.M. Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: con – ‘life is really simple, but we insist on making it complicated’. Eur J Anaesthesiol. 2011; 28: 155-159 Crossref PubMed Scopus (45) Google Scholar ,6 Kranke P. Effective management of postoperative nausea and vomiting: let us practice what we preach. Eur J Anaesthesiol. 2001; 28: 152-154 Crossref Scopus (26) Google Scholar Therefore, current clinical guidelines support a more liberal multimodal approach to PONV prophylaxis, 7 Kranke P. Meybohm P. Diemunsch P. Eberhart L.H. Risk-adapted strategy or universal multimodal approach for PONV prophylaxis?. Best Pract Res Clin Anaesthesiol. 2020; 34: 721-734 Crossref PubMed Scopus (12) Google Scholar with the latest update of PONV consensus guidelines recommending multimodal anti-emetic prophylaxis with at least two anti-emetic drugs administered to every patient plus an additional anti-emetic drug in high-risk patients. 1 Gan T.J. Belani K.G. Bergese S. et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020; 131: 411-448 Crossref PubMed Scopus (307) Google Scholar