J U LY 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 3 5
bolus of propofol followed by an infu-
sion of 20 mcg/kg/min also reduces the
overall risk of PONV.
• Don't count on neostigmine.
Although avoiding the use of the mus-
cle relaxant reversal agent neostigmine
has long been viewed as a way to
reduce the risk of PONV, new research
shows the drug's effects are minimal.
The latest SAMBA guidelines remove it
from the list of ways to reduce the
baseline risk of PONV.
Effective combinations
The updated guidelines included sever-
al newer drugs that have proven effec-
tive in lowering PONV risk: the 5-HT3
receptor antagonists ramosetron and
palonosetron; the NK-1 receptor antag-
onists aprepitant, casopitant and rolap-
itant; the corticosteroid methylpred-
nisolone; the butyrophenone haloperi-
dol; and the antihistamine meclizine.
Adult patients at moderate risk of
PONV should receive combination
therapy with antiemetics that target
different receptors. There is no one
combination that works better than
others, but combinations involving
• Use regional anesthesia in place of
general anesthesia when possible.
• Use propofol for induction and
maintenance of anesthesia.
• Avoid nitrous oxide.
• Avoid volatile anesthetics.
• Use intraoperative and post-op opi-
oids sparingly.
• Ensure adequate hydration.
— TJ Gan, MD
REDUCE THE RISK
6 Practical Ways
To Prevent PONV
• LOCAL STOP Placing regional blocks instead of administer-
ing general anesthesia is one way to help lower PONV risks.
