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Evidence-based Practice and Quality Improvement

Is PONV still a problem?


Pechhold, M.; Walldén, J.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 8-8
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Background and Goal of Study: It is fairly known how evidence-based PONV-prophylactic regimes are implemented in routine clinical settings (1). With active prohylaxic regimes PONV-rates are expected to be reduced (2). The aim of the study was to evaluate how PONV-prophylaxis are used in a clinical setting were the departmental routine is to give prophylaxis according to PONV-risk.

Materials and Methods: As a first part of a larger observational study regarding PONV at a County Hospital in Sweden, we studied 110 adult patients undergoing day-case procedures (orthopedic or general surgery). Independent of the anesthesiologists preoperative assessment we evaluated riskfactors for PONV and retrieved an Apfel-score (3) for each patient. We regarded the PONV-prophylaxis as suboptimal when Apfel-score was higher than 1 + the number of given prophylactic drugs. Events of nausea and vomiting were evaluated postoperatively through questionaries at 2, 4 and 6 hours after surgery and once daily up to the third postoperative day.

Results and Discussion: 29 % (n=32) of the patients received suboptimal prophylax. The rate of patients with events of nausea and/or vomiting related to prophylaxis are presented in the table.

[Event rates of nausea or vomiting]

Conclusions: Even with active prophylactic regimes, 29% of the patients did not receive optimal prophylaxis and the PONV-rate was high in this group. To further reduce PONV in routine clinical settings, more efforts must be made to implement and follow evidence-based guidelines.


1. Kranke, EJA 2011:28:758-765
    2. Gan et al, Anesth Analg 2003:97:62-71
      3. Apfel et al, Anesthesiology 1999:91:693-700
        © 2013 European Society of Anaesthesiology