Watcha proposed guidelines for the cost-effective management of a postoperative patients to reduce the risk of postoperative nausea and vomiting (PONV). The author is from the Children's Hospital of Philadelphia.
Risk factors for PONV utilized:
(1) gender
(2) smoking status
(3) previous history of PONV or motion sickness
(4) opioid use
|
Parameter |
Finding |
Points |
|
gender |
male |
0 |
|
|
female |
1 |
|
smoking status |
smoker |
0 |
|
|
nonsmoker |
1 |
|
history of PONV or motion sickness |
absent |
0 |
|
|
present |
1 |
|
opioid use |
no |
0 |
|
|
yes |
1 |
where:
• These are the same risk factors as used in the simplified risk score of Apfel et al.
number of risk factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The higher the number of risk factors, the higher the PONV risk.
|
number of risk factors |
PONV risk |
|
0 |
low |
|
1 |
mild |
|
2 |
moderate |
|
3 |
high |
|
4 |
extremely high |
|
PONV Risk |
Prophylaxis |
Rescue |
|
low |
none |
ondansetron 1 mg or dolasetron 12.5 mg |
|
mild |
droperidol 1.25 mg |
ondansetron 1 mg or dolasetron 12.5 mg |
|
moderate |
droperidol 1.25 mg |
ondansetron 1 mg or dolasetron 12.5 mg |
|
high |
droperidol 1.25 mg plus steroid and/or metoclopramide |
ondansetron 1 mg or dolasetron 12.5 mg |
|
extremely high |
droperidol 1.25 mg plus steroid plus ondansetron 8 mg (or dolasetron 12.5 mg) |
metoclopramide, phenothiazine, additional 5HT3 antagonists or other antiemetic |
Specialty: Anesthesiology, Gastroenterology, Pharmacology, clinical
