Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesPrevention of postoperative nausea and vomiting[Dr John La Rosa and Dr Krish Ramachandran, May 2006; appraised by Dr LaRosa, January 2010]Anaesthetists should consider the likelihood of postoperative nauseaand vomiting (PONV) in all their patients, and give consideration toreducing the probability that PONV will occur. This may be by acombination of general measures that should be considered for allpatients and specific prophylactic drug therapy for those patients athigher than minimal risk.The routine use of granisetron for every patient is not appropriate.(Granisetron was withdrawn from trust purchasing from November2006).The individual professional anaesthetist holds responsibility forappropriate prescription and administration to patients.General measures to considerNot all these measures will be appropriate in all cases.• Avoid volatile anaesthesia and use IVA instead.• Give postoperative supplemental oxygen.• Avoid nitrous oxide where not specifically indicated.• Use local anaesthetics either to reduce opiate use or in place ofgeneral anaesthesia.• Give intravenous fluids to reduce the effect of preoperativedehydration.• Limit periods of preoperative fasting.• Avoid neostigmine – give only when indicated.Count the risk factorsOne point for each of the following:Anaesthetists Handbook January 2010 227