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Updated: Dec 21, 2025

Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Preventing Nausea and Vomiting After Bariatric Surgery: Is the Apfel Risk Prediction Score Enough to Guide
Patrick Ziemann-Gimmel1,2, Roman Schumann3,4, Wayne English5
1Associate Professor of Anesthesiology, University of Central Florida, Orlando, FL, USA. pziemann@yahoo.com.
Abstract:
Postoperative nausea and vomiting (PONV) is a frequent side effect in patients undergoing bariatric procedures. The simplified Apfel score is an attractive and frequently used tool to assess PONV risk in the general surgical population. Despite applying the recommendations based on the Apfel risk prediction score, several studies show that up to 82% of patients undergoing metabolic and bariatric surgery suffer from PONV in the PACU. A combination of multiple antiemetic drugs of different pharmacologic classes targeting a variety of receptors in addition to an intraoperative opioid-free TIVA technique should be considered in high-risk patients.
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