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16 - Antiemetics
- By John Carlisle, Department of Anaesthetics, NHS Torbay Hospital, Torquay, Devon, UK
Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
Book:

Evidence-based Anaesthesia and Intensive Care

Published online:

05 September 2009

Print publication:

09 October 2006, pp 169-183
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Summary

This chapter discusses three groups of interventions that reduce the number of people who experience postoperative nausea or vomiting (PONV). It concentrates on the eight drugs that reliably reduced PONV from the 60 patients assessed in the Cochrane Systematic Review. The chapter lists the drugs in order, with the drug that has the most certain antiemetic effect first and the drug that has the least certain antiemetic effect last. There is less known about the effects of drugs used to treat PONV than there is about drugs used to prevent PONV. Omission of nitrous oxide (N2O) from the inhalational maintenance of anaesthesia reduces PONV. Maintenance of general anaesthesia with intravenous propofol instead of a volatile agent reduces the risk of PONV. There is less direct evidence for using regional analgesia instead of systemic analgesia and reducing opioid use, although there is substantial indirect evidence that this limits PONV.