Document Detail

Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment.
MedLine Citation:
PMID:  21079721     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The German-language recommendations for the management of postoperative nausea and vomiting (PONV) have been revised by an expert committee. Major aspects of this revision are presented here in the form of an evidence-based review article.
METHODS: The literature was systematically reviewed with the goal of revising the existing recommendations. New evidence-based recommendations for the management of PONV were developed, approved by consensus, and graded according to the scheme of the Scottish Intercollegiate Guidelines Network (SIGN).
RESULTS: The relevant risk factors for PONV include female sex, nonsmoker status, prior history of PONV, motion sickness, use of opioids during and after surgery, use of inhalational anesthetics and nitrous oxide, and the duration of anesthesia. PONV scoring systems provide a rough assessment of risk that can serve as the basis for a risk-adapted approach. Risk-adapted prophylaxis, however, has not been shown to provide any greater benefit than fixed (combination) prophylaxis, and PONV risk scores have inherent limitations; thus, fixed prophylaxis may be advantageous. Whichever of these two approaches to manage PONV is chosen, high-risk patients must be given multimodal prophylaxis, involving both the avoidance of known risk factors and the application of multiple validated and effective antiemetic interventions. PONV should be treated as soon as it arises, to minimize patient discomfort, the risk of medical complications, and the costs involved.
CONCLUSION: PONV lowers patient satisfaction but is treatable. The effective, evidence-based measures of preventing and treating it should be implemented in routine practice.
Dirk Rüsch; Leopold H J Eberhart; Jan Wallenborn; Peter Kranke
Publication Detail:
Type:  Journal Article; Review     Date:  2010-10-22
Journal Detail:
Title:  Deutsches Ärzteblatt international     Volume:  107     ISSN:  1866-0452     ISO Abbreviation:  Dtsch Arztebl Int     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-11-16     Completed Date:  2011-03-29     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101475967     Medline TA:  Dtsch Arztebl Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  733-41     Citation Subset:  IM    
Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg GmbH.
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MeSH Terms
Acupuncture Therapy
Analgesia, Patient-Controlled
Analgesics, Opioid / administration & dosage,  adverse effects
Anesthesia, General / adverse effects*
Antiemetics / therapeutic use
Child, Preschool
Combined Modality Therapy
Complementary Therapies
Drug Therapy, Combination
Evidence-Based Medicine*
Patient Satisfaction
Postoperative Nausea and Vomiting / etiology*,  prevention & control,  therapy*
Risk Assessment
Reg. No./Substance:
0/Analgesics, Opioid; 0/Antiemetics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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