SAMBA PONV guidelines : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Aliases:

Society for Ambulatory Anaesthesia PONV Guidelines

Topic aliases are alternate phrasings for a particular topic.

PONV SAMBA Guidelines (Society for Ambulatory Anaesthesia)

A. Stratify risk (Adult or Paed)
B. Reduce baseline risk factors for PONV
C. PONV Prophylaxis

A. Stratify risk
ADULT
1. Female
2. Non-smoker
3. History PONV/motion sickness
4. Postop opiods

PAEDIATRIC
1. Surgery >30min
2. Age > 3yrs
3. Strabismus surgery
4. History of PONV

Number of risk factors (0-4)
0 - 10%,
1 - 20%,
2 - 40%,
3 - 60%,
4 - 80%

B. Reduce baseline risk factors for PONV

- Avoid volatile 20% reduction (NNT = 5) in early PONV (<2hrs)
- Avoid N2O 12% (NNT = ?)
- Minimise intraop/postop opiods
- minimise dehydration
- avoid high dose neostigmine

C. PONV Prophylaxis

Low risk
-wait and see
Medium risk
-1-2 interventions for adults, 2 interventions for children
High risk
> 2 interventions

INTERVENTIONS
-TIVA
-Regional
-Dexamethasone 4mg (at induction)
-Droperidol 0.625-1.25mg IV (at end of case)
-Promethazine 6.25-25mg IV(phenergen, at induction)/Prochlorperazine5-10mg IV (stemetil, at end of surgery)
-5HT3 antagonists (Ondastetron 4mg IV/granisetron/tropisetron)
Propofol rescue in PACU

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