Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. In this article we describe the development and evaluation of a management protocol for PONV, which consists of a treatment algorithm accompanied by a nursing education program. Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload.
It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.
OrkinF.K.What do patients want?—preferences for immediate postoperative recovery (abstract).Anesth Analg1992; 74: S225.
2.
HirschJ.Impact of postoperative nausea and vomiting in the surgical setting.Anaesthesia1994; 49(suppl.): 30–33.
3.
MorrisR.W., ErnstE., GreavesD.J., LayfieldD.J., MichaelR.F.An audit of the incidence and costs associated with postoperative nausea and vomiting (PONV) following major gynaecological surgery in an inpatient population.Br J Anaesth1993; 70(suppl.): A.2.
4.
van WijkM.G.F., SmalhoutB.A postoperative analysis of the patient's view of anaesthesia in a Netherlands teaching hospital.Anaesthesia1990; 45: 679–682.
5.
GreenG., JonssonL.Nausea: the most important factor determining length of stay after ambulatory anaesthesia.A comparative study of isoflurane and/or propofol techniques Acta Anaesth Scand1993; 37: 742–746.
6.
WatchaM.F., WhiteP.F.Postoperative nausea and vomiting. Its etiology, treatment and prevention.Anesthesiology1992; 77: 162–184.
7.
KapurP.A.Editorial: The Big “Little Problem” (editorial).Anesth Analg1991; 73: 243–245.
8.
RowbothamD.J., SmithG.Introduction. Supplement on postoperative nausea and vomiting.Br J Anaesth1992; 7(suppl. 1): 1S.
9.
RussellD., KennyG.N.C.5-HT3 antagonists in postoperative nausea and vomiting.Br J Anaesth1992; 69(suppl. 1): 63S–68S.
10.
JoslynA.F.Ondansetron, clinical development for postoperative nausea and vomiting: current studies and future directions.Anaesthesia1994; 49(suppl.): 34–37.
11.
KoivurantaM., LaaraE., SnareL., AlahuhtaS.A survey of postoperative nausea and vomiting.Anaesthesia1997; 52: 443–449.
12.
SuenT.K.L., GinT.A., ChenP.P., RowbottomY.M., CritchleyL.A.H., RayA.K.Ondansetron 4 mg for the prevention of nausea and vomiting after minor laparoscopic gynaecological surgery.Anaesth Intens Care1994; 22: 142–146.
13.
BodnerM., WhiteP.Antiemetic efficacy of ondansetron after outpatient laparoscopy.Anesth Analg1991; 73: 250–254.
14.
KennyG.N.C., OatesJ.D.L., LeeseeJ.Efficacy of orally administered ondansetron in the prevention of postoperative nausea and vomiting; a dose ranging study.Br J Anaesth1992; 68: 466–470.
15.
PaechM.J., PavyT.J.G., EvansS.F.Single-dose prophylaxis for postoperative nausea and vomiting after major abdominal surgery: ondansetron versus droperidol.Anaesth Intens Care1995; 23: 548–554.
16.
TramerM., MooreA., McQuayH.Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies.Br J Anaesth1997; 78: 247–255.
17.
DivatiaJ.V., VaidyaJ.S., BadweR.A., HawaldarR.W.Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting. A meta-analysis.Anesthesiology1996; 85: 1055–1062.
18.
Wilder-SmithO.H.G., MartinN.C., MorabiaA.Postoperative nausea and vomiting: a comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons.Anesth Analg1997; 84: 826–831.
19.
KapurP.A.Pharmacy acquisition costs: responsible choices versus overutilization of costly pharmaceuticals (editorial).Anesth Analg1994; 78: 617–618.
