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What’s New in PONV Prevention?
The latest recommendations include a multimodal approach — and a key change on antiemetic treatment.
Tong J (TJ) Gan, MD, MBA, MHS, FRCA
Publish Date: August 16, 2022   |  Tags:   Anesthesia Patient Experience
ALL TOO COMMON The incidence of PONV ranges from 30% in the general surgical population to as high as 80% in high-risk patients.   |   Pamela Bevelhymer

Your surgical team just successfully completed a total hip replacement with robotic assistance on a 70-year-old woman. The anesthesia provider administered ondansetron, a serotonin 5-HT3 receptor antagonist, during the surgery, which was performed with general anesthesia. The patient wakes up groggy, but relieved the procedure was successful. That feeling stops when she’s hit with an overwhelming wave of nausea. Now all your patient can focus on is how sick she feels. Not only can PONV wreak havoc on satisfaction scores, but it can also disrupt surgical outcomes if the patient undergoes a procedure such as a facelift, eye surgery or neurosurgery. The worst part is, in many cases, the unfortunate outcome could’ve been avoided.

While PONV is a common complication — ranging from around 30% in the general surgical population to as high as 80% in high-risk patients — it is often preventable. I recently chaired the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting (osmag.net/PONV), which were endorsed by 23 national and international professional organizations, including the American Society of Anesthesiologists and the American Academy of Nurse Anesthetists. The guidelines cover successful strategies that involve a multimodal approach combining antiemetics with effective, emerging prophylactic modalities.

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