Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Area of Science:

• Anesthesiology
• Pharmacology
• Surgical Care

Background:

• Postoperative nausea and vomiting (PONV) remains a significant concern for patients undergoing surgery.
• Existing guidelines for PONV management were outdated or limited in scope.
• There was a need for comprehensive, evidence-based recommendations incorporating recent advancements.

Purpose of the Study:

• To establish updated, comprehensive guidelines for the prevention and treatment of PONV in adult and pediatric populations.
• To provide evidence-based recommendations on risk stratification, prophylaxis, and rescue treatments for PONV.
• To guide the implementation of PONV protocols within enhanced recovery pathways.

Main Methods:

• A systematic review of literature up to September 2019 was conducted.
• An international expert panel evaluated evidence on risk factors, prophylaxis, and treatment options.
• Guidelines were developed based on the consensus of the expert panel and endorsed by multiple professional societies.

Main Results:

• The guidelines offer recommendations for identifying high-risk patients and managing baseline PONV risks.
• Evidence for newer drugs, including second-generation 5-HT3 receptor antagonists, NK1 receptor antagonists, and dopamine antagonists, is discussed.
• Recommendations include general multimodal PONV prophylaxis and PONV management within enhanced recovery pathways.

Conclusions:

• The updated guidelines provide perioperative practitioners with comprehensive, evidence-based guidance on PONV management.
• The guidelines address PONV in both adult and pediatric populations, including its management within enhanced recovery pathways.
• These guidelines are endorsed by 23 professional societies, signifying broad consensus and applicability.