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Anaesthetic & Pain Management Service
University Hospital Wishaw
Antiemetic Guideline (PONV) for
Adult Inpatients in the Perioperative Period
MPR.ANTIEM.22_13782.W
APFEL’S Risk Assessment
Risk Factors No of Factors Risk of PONV
Female None 10% LOW
Non smoker 1 20%
			MEDIUM
History of PONV 2 40%
Opioids used 3 60% HIGH
4 80% HIGH
Pre-operatively: Reduce Baseline Risk. Consider prophylactic anti-emetics
• Consider regional anaesthesia
• If GA used reduce risk factors eg, inhalational agents, long acting opioids, Nitrous Oxide
• Consider propofol for induction and maintenance
1. No prophylactic drug for low risk group, prescribe ondansetron PRN
2. 1 - 2 drugs for medium risk or 2 or more for high risk patients
3. High Risk - double or triple prophylaxis from different classes. Either Granisetron 1mg at
induction or Ondansetron 4mg +/- Dexamethasone 3.3 to 6.6mg IV at induction, +/- Droperidol
0.625 - 1.25mg IV (caution regarding QT prolongation interactions).
• Regular ongoing treatment Ondansetron 4mg three times daily iv for up to 5 days.
Effective? No
Yes
Continue
Continue 1. Call patients list anaesthetist, if
unavailable;
2. Call Acute Pain/Clinical Nurse specialists
S Anderson/L Steele DECT 6224/Pg 021,
if unavailable;
3. Call ACCU Pg 003 out-of-hours.
Tips
• Some patients will require regular
antiemetics using 2 or more drugs.
• Ondansetron 4mg IV/IM repeated 8 hourly.
• Prochlorperazine 12.5mg IM, 10-20mg PO
8 hourly, 3-6mg buccal bd.
• Cyclizine, 50mg IV/IM/PO 8 hourly (25mg
in elderly).
• Repetition of the same antiemetic within
6 hours may not be effective - choose
another drug.
• Dexamethasone dose should not be
repeated.
• Cyclizine, droperidol - better antinausea
profile.
• Ondansetron - better antiemetic.
• Granisetron - longer acting alternative
to Ondansetron
• Droperidol - good for opioid induced
(PCA) N & V.
Effective? No
Yes
Approved
by:
C
Slorach/S
Anderson/L
Steele/J
Murphy.
Jun
2022.
Review
date:
Jun
2027
Post-operative: Treatment of Nausea and Vomiting
Target Group: Medical & Nursing Staff in Surgical Wards, Theatres & SHDU
Keywords: Nausea; Vomiting; PONV; Antiemetic
1st Line - Ondansetron 4mg IV/IM
2nd Line - Cyclizine 25 - 50mg IV/IM
3rd Line - Dexamethasone 3.3 to 6.6mg IV if not already given/
contraindicated.
Prochlorperazine 12.5mg IM, 10-20mg PO 8 hourly, 3 - 6mg buccal bd
4th Line - Droperidol 0.625 - 1.25mg IV (caution regarding QT
prolongation interactions).

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antiemetic-guideline-ponv-adult-inpatient.pdf

  • 1. Anaesthetic & Pain Management Service University Hospital Wishaw Antiemetic Guideline (PONV) for Adult Inpatients in the Perioperative Period MPR.ANTIEM.22_13782.W APFEL’S Risk Assessment Risk Factors No of Factors Risk of PONV Female None 10% LOW Non smoker 1 20% MEDIUM History of PONV 2 40% Opioids used 3 60% HIGH 4 80% HIGH Pre-operatively: Reduce Baseline Risk. Consider prophylactic anti-emetics • Consider regional anaesthesia • If GA used reduce risk factors eg, inhalational agents, long acting opioids, Nitrous Oxide • Consider propofol for induction and maintenance 1. No prophylactic drug for low risk group, prescribe ondansetron PRN 2. 1 - 2 drugs for medium risk or 2 or more for high risk patients 3. High Risk - double or triple prophylaxis from different classes. Either Granisetron 1mg at induction or Ondansetron 4mg +/- Dexamethasone 3.3 to 6.6mg IV at induction, +/- Droperidol 0.625 - 1.25mg IV (caution regarding QT prolongation interactions). • Regular ongoing treatment Ondansetron 4mg three times daily iv for up to 5 days. Effective? No Yes Continue Continue 1. Call patients list anaesthetist, if unavailable; 2. Call Acute Pain/Clinical Nurse specialists S Anderson/L Steele DECT 6224/Pg 021, if unavailable; 3. Call ACCU Pg 003 out-of-hours. Tips • Some patients will require regular antiemetics using 2 or more drugs. • Ondansetron 4mg IV/IM repeated 8 hourly. • Prochlorperazine 12.5mg IM, 10-20mg PO 8 hourly, 3-6mg buccal bd. • Cyclizine, 50mg IV/IM/PO 8 hourly (25mg in elderly). • Repetition of the same antiemetic within 6 hours may not be effective - choose another drug. • Dexamethasone dose should not be repeated. • Cyclizine, droperidol - better antinausea profile. • Ondansetron - better antiemetic. • Granisetron - longer acting alternative to Ondansetron • Droperidol - good for opioid induced (PCA) N & V. Effective? No Yes Approved by: C Slorach/S Anderson/L Steele/J Murphy. Jun 2022. Review date: Jun 2027 Post-operative: Treatment of Nausea and Vomiting Target Group: Medical & Nursing Staff in Surgical Wards, Theatres & SHDU Keywords: Nausea; Vomiting; PONV; Antiemetic 1st Line - Ondansetron 4mg IV/IM 2nd Line - Cyclizine 25 - 50mg IV/IM 3rd Line - Dexamethasone 3.3 to 6.6mg IV if not already given/ contraindicated. Prochlorperazine 12.5mg IM, 10-20mg PO 8 hourly, 3 - 6mg buccal bd 4th Line - Droperidol 0.625 - 1.25mg IV (caution regarding QT prolongation interactions).