Figure 2:
Algorithm for the management of post-operative nausea and vomiting in adults
1. Risk factors
- Female sex
- Younger age
- Non-smoker
- Surgery type
- History of post-operative nausea and vomiting or motion sickness
- Opioid analgesia
2. Risk mitigation
- Minimise use of nitrous oxide, volatile anaesthetics and high-dose neostigmine
- Consider regional anaesthesia
- Opioid sparing/multi-modal analgesia (enhanced recovery pathways)
3. Risk stratification
Quantify the number of risk factors to determine risk and guide anti-emetic therapy:
- 1 to 2 risk factors → Give 2 agents
- More than 2 risk factors → Give 3 to 4 agents
4. Prophylaxis
- 5-HT₃ receptor antagonists
- Antihistamines
- Propofol anaesthesia
- Acupuncture
- Corticosteroids
- Dopamine antagonists
- NK-1 receptor antagonists
- Anticholinergics
5. Rescue treatment
Use anti-emetic from different class than prophylactic drug
Source: adapted Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth. Analg. 131(2):411-448, August 2020