[Prophylaxis and treatment of nausea and vomiting after outpatient ophthalmic surgery]

Postoperative nausea and vomiting (PONV) are the most common side effects following anesthesia. It is unpleasant for the patients and has significant impact on postoperative well-being. After ophthalmic surgery arterial hypertension caused by retching and vomiting can cause intraocular bleeding with detrimental effects on the result of surgery. It is possible to identify risk patients who are likely to develop PONV. In these patients antiemetic prophylaxis is indicated, but the extreme age of patients (geriatric patients with relevant comorbidity and children) undergoing (ambulatory) ophthalmic procedures must be considered. Furthermore, antiemetics should be free from side effects, especially sedating effects, since these procedures are often performed on an outpatient basis. Regional or local anesthesia is the method of choice. However, when general anesthesia is necessary avoidance of volatile anesthetics, nitrous oxide, and administration of 5-HT(3) antagonists is recommended. Also, dexamethasone is a potent antiemetic drug that can favorably be combined with the 5-HT(3) antagonists. Dimenhydrinate is well accepted and an effective antiemetic for pediatric patients. By combining these antiemetic measures PONV can be lowered to a clinically satisfying level even in high-risk patients.