<p class="first" id="d36605054e407">This consensus statement presents a comprehensive
and evidence-based set of guidelines
for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric
populations. The guidelines are established by an international panel of experts under
the auspices of the American Society of Enhanced Recovery and Society for Ambulatory
Anesthesia based on a comprehensive search and review of literature up to September
2019. The guidelines provide recommendation on identifying high-risk patients, managing
baseline PONV risks, choices for prophylaxis, and rescue treatment of PONV as well
as recommendations for the institutional implementation of a PONV protocol. In addition,
the current guidelines focus on the evidence for newer drugs (eg, second-generation
5-hydroxytryptamine 3 [5-HT3] receptor antagonists, neurokinin 1 (NK1) receptor antagonists,
and dopamine antagonists), discussion regarding the use of general multimodal PONV
prophylaxis, and PONV management as part of enhanced recovery pathways. This set of
guidelines have been endorsed by 23 professional societies and organizations from
different disciplines (Appendix 1).Guidelines currently available include the 3 iterations
of the consensus guideline we previously published, which was last updated 6 years
ago; a guideline published by American Society of Health System Pharmacists in 1999;
a brief discussion on PONV management as part of a comprehensive postoperative care
guidelines; focused guidelines published by the Society of Obstetricians and Gynecologists
of Canada, the Association of Paediatric Anaesthetists of Great Britain & Ireland
and the Association of Perianesthesia Nursing; and several guidelines published in
other languages.The current guideline was developed to provide perioperative practitioners
with a comprehensive and up-to-date, evidence-based guidance on the risk stratification,
prevention, and treatment of PONV in both adults and children. The guideline also
provides guidance on the management of PONV within enhanced recovery pathways.The
previous consensus guideline was published 6 years ago with a literature search updated
to October 2011. Several guidelines, which have been published since, are either limited
to a specific populations or do not address all aspects of PONV management. The current
guideline was developed based on a systematic review of the literature published up
through September 2019. This includes recent studies of newer pharmacological agents
such as the second-generation 5-hydroxytryptamine 3 (5-HT3) receptor antagonists,
a dopamine antagonist, neurokinin 1 (NK1) receptor antagonists as well as several
novel combination therapies. In addition, it also contains an evidence-based discussion
on the management of PONV in enhanced recovery pathways. We have also discussed the
implementation of a general multimodal PONV prophylaxis in all at-risk surgical patients
based on the consensus of the expert panel.
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