Prophylaxis for postoperative nausea and vomiting (PONV) in adults

PONV: postoperative nausea and vomiting; TIVA: total intravenous anesthesia; 5HT: 5 hydroxytryptamine.
* The choice of PONV prophylaxis must take into account the medical and surgical risks of PONV (eg, disruption of surgical repair, increase in intracranial pressure) and patient and provider preferences.
¶ A variety of antiemetics acting via different mechanisms are used for PONV prophylaxis.

• Choice of agents is based upon side effect profile, personal experience, cost, and formulary considerations
• Commonly used antiemetics and categories include:
  • 5HT receptor antagonists (eg, ondansetron)
  • Dexamethasone
  • Scopolamine transdermal
  • Neurokinin receptor antagonists (eg, aprepitant)
  • Antihistamines (eg, dimenhydrinate or diphenhydramine)
  • Antidopaminergics (eg, haloperidol)
• When more than 1 antiemetic is administered, drugs from different classes should be chosen as the beneficial effects of antiemetics that act on different receptors are additive.

Δ Many clinicians offer PONV prophylaxis with ≥1 antiemetic to low-risk patients.