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Published Online, 2 January 2007, www.theannals.com, DOI 10.1345/aph.1H398.
 The Annals of Pharmacotherapy: Vol. 41, No. 1, pp. 68-78. DOI 10.1345/aph.1H398
© 2007 Harvey Whitney Books Company.
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SURGERY

Prevention of Postoperative Nausea and Vomiting

Sheila M Wilhelm, PharmD

Assistant Professor, Department of Pharmacy Practice, Wayne State University, Detroit, MI

Michelle L Dehoorne-Smith, PharmD

Manager of Patient Care Services, St. John Hospital and Medical Center, Detroit

Pramodini B Kale-Pradhan, PharmD

Associate Professor, Department of Pharmacy Practice, Wayne State University, St. John Hospital and Medical Center

Reprints: Dr. Kale-Pradhan, Wayne State University, Department of Pharmacy Services, St. John Hospital and Medical Center, 22101 Moross Rd., Detroit, MI 48236, fax 313/343-7632, pkale{at}wayne.edu

OBJECTIVE: To review the literature on the prevention of postoperative nausea and vomiting (PONV) in adults.

DATA SOURCES: Literature retrieval was accessed through MEDLINE (1966–December 2006) using the terms postoperative nausea and vomiting, prevention and treatment. Article references were hand-searched for additional relevant articles and abstracts.

STUDY SELECTION AND DATA EXTRACTION: All studies published in English were evaluated. Those dealing with prevention and treatment of PONV in adults were included in the review.

DATA SYNTHESIS: Evidence suggests that providing prophylactic antiemetic medications in high-risk surgical patients is warranted. 5-HT3 receptor antagonists are widely used, with no one agent being clearly superior. However, studies have shown other types of agents to be more cost-effective.

CONCLUSIONS: The first step in the prevention of PONV is assessment and reduction of risk factors. Although nonpharmacologic therapies may play a role in the treatment of PONV, the mainstay of therapy for PONV is pharmacologic modalities. Patients at moderate to high risk for PONV need prophylactic antiemetic therapy. High-risk patients may require combination therapy with 2 or 3 agents from different antiemetic classes. Rescue antiemetic therapy is needed by patients who actually develop PONV. The agents of choice in such cases should be from antiemetic classes different from those used for prophylaxis of PONV.

Key Words: dexamethasone, dimenhydrinate, droperidol, 5-HT3 antagonists, neurokinin-1, postoperative nausea and vomiting, prochlorperazine, scopolamine

Published Online, January 2, 2007. www.theannals.com, DOI 10.1345/aph.1H398

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-07-001-H01




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