What is the perioperative management of antiemetics?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Patient populations at risk for postoperative nausea and vomiting include those scheduled for ophthalmologic surgery, patients with a prior history of nausea and vomiting or motion sickness, patients scheduled for laparoscopic surgery or gynecologic procedures, and patients who are obese.

A risk score for predicting postoperative nausea and vomiting after inhalation anesthesia identified 4 risk factors: female sex, nonsmoking, prior history of motion sickness or postoperative nausea, and the use of postoperative opioids. One study suggests prophylactic antiemetic therapy when 2 or more of the risk factors are present when using volatile anesthetics. Ondansetron (4 mg IV), dexamethasone (4 mg IV), droperidol (0.625 mg IV), diphenhydramine (Benadryl) (25 mg IV), and scopolamine transdermal patch (1.5 mg) singly or in combination, are agents in common usage. [18]

Most anesthesiologists believe antiemetics should be administered 30 minutes prior to the end of the case (except dexamethasone on induction and scopolamine patch preoperatively). As always, clinicians should consider reduction of baseline risks, including avoidance/minimization of nitrous oxide, volatile anesthetics, high-dose neostigmine, and postoperative opioids.


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