PONV is an unwelcome problem in the peri-operative period.
Effective drug treatment requires a planned management protocol that includes intravenous anti-emetic administration at appropriate time intervals (ie, if a specific agent hasn't worked by the time it should have, give something else!). Drugs included in a PONV protocol should span the range of pathways involved. Medical review is needed for any patient with refractory PONV to exclude a surgical or medical cause.
When reviewing abstracts, note the difference between prophylaxis and treatment protocols, and also between nausea and vomiting. Hospitals should have a prophylaxis protocol that identifies at-risk groups and the agent/s they should be offered, and independently a treatment protocol for nurses to use in the peri-operative period for anyone afflicted with PONV.
Annalyn Kuok provides this point-form summary of PONV and its management.
Paul White discussess 5-HT3 antagonists in the ambulatory setting.
If you're registered, this MedScape article is good.
This chapter is kindly sponsored by Wavelength Consulting International Medical Recruitment and Locum Service. We are most grateful for their assistance.
Questions about the Virtual Anaesthesia Textbook project itself should be e-mailed to Chris Thompson.