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Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Gan, Tong J. MD, MHS, FRCA*; Diemunsch, Pierre MD, PhD; Habib, Ashraf S. MB, FRCA*; Kovac, Anthony MD; Kranke, Peter MD, PhD, MBA§; Meyer, Tricia A. PharmD, MS, FASHP; Watcha, Mehernoor MD; Chung, Frances MBBS#; Angus, Shane AA-C, MS**; Apfel, Christian C. MD, PhD††; Bergese, Sergio D. MD‡‡; Candiotti, Keith A. MD§§; Chan, Matthew TV MB, BS, FANZCA‖‖; Davis, Peter J. MD¶¶; Hooper, Vallire D. PhD, RN, CPAN, FAAN##; Lagoo-Deenadayalan, Sandhya MD, PhD***; Myles, Paul MD†††; Nezat, Greg CRNA, CDR, USN, PhD§§§; Philip, Beverly K. MD‖‖‖; Tramèr, Martin R. MD, DPhil¶¶¶

doi: 10.1213/ANE.0000000000000002
Ambulatory Anesthesiology: Special Article

The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

Supplemental Digital Content is available in the text.

From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Service d’Anesthésiologie–Réanimation Chirurgicale, CHU de Hautepierre, and EA 3072, Faculté de Médecine, Strasbourg, France; Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; §Department of Anesthesiology, University of Wuerzburg, Wuerzburg, Germany; Department of Pharmacy/Anesthesiology, BaylorScott & White Health, Temple, Texas Department of Anesthesiology & Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas; #Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; **Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, Washington, District of Columbia; ††Department of Anesthesia and Perioperative Care, UCSF Medical Center at Mt. Zion, San Francisco, California; ‡‡Department of Anesthesiology, Wexner Medical Center, Ohio State University, Columbus, Ohio; §§Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami, Miami, Florida; ‖‖Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; ¶¶Department of Anesthesia, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ##System Nursing Education and Research, Mission Health System, Asheville, North Carolina; ***Department of Surgery, Duke University Medical Center, Durham, North Carolina; †††Department of Anaesthesia and Perioperative Medicine, Alfred Hospital; Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; §§§Naval Medical Center Portsmouth, Porstmouth, Virginia; ‖‖‖Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and ¶¶¶Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.

Accepted for publication September 13, 2013.

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Funding: Not funded.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Tong J. Gan, MD, Department of Anesthesiology, Duke University Medical Center, PO Box 3094, Durham, NC 27710. Address e-mail to

© 2014 International Anesthesia Research Society