This handout is for postoperative nausea and vomiting. Your care team identified this based on: postoperative nausea (within 24h of anesthesia) (samba 2020).
Other reasons your team may use this plan: postoperative vomiting or retching (within 24h of anesthesia) (samba 2020); apfel score >=2 (female + nonsmoker + prior ponv/motion sickness + postop opioids) (apfel 1999); laparoscopic, gynecologic, ent, breast, ophthalmologic, or strabismus surgery (samba 2020).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| tiva_propofol_instead_of_volatile_when_high_risk | Propofol TIVA | IV | continuous | TIVA reduces PONV vs volatile (SAMBA 2020) |
| opioid_sparing_multimodal_analgesia | Regional block + NSAID + acetaminophen + ketamine low-dose | multimodal | perioperative | Opioids are 1 Apfel point; minimize (SAMBA 2020, Apfel 1999) |
| adequate_iv_hydration_carb_loading_preop | 20-30 mL/kg crystalloid intraop; preop carbohydrate drink | IV/PO | perioperative | Hydration reduces PONV (SAMBA 2020) |
| avoid_nitrous_oxide_when_high_risk | Omit N2O | inhaled | continuous | N2O contributes to PONV at exposures >1h (SAMBA 2020) |
Plan: PONV — SAMBA 2020 Apfel-matched multimodal prophylaxis + class-different rescue
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Document PONV event in chart for future anesthetics; counsel re prior-PONV factor and aprepitant prophylaxis for future high-risk surgery (SAMBA 2020)
Guideline: SAMBA / Fourth Consensus Guidelines for Management of Postoperative Nausea and Vomiting (Gan TJ et al, Anesth Analg 2020) + Apfel CC simplified risk score (Anesthesiology 1999)