Guias De Consenso Para El Manejo De Nvpo

SPECIAL ARTICLE

Consensus Guidelines for Managing Postoperative Nausea and Vomiting
Tong J. Gan, MD*, Tricia Meyer, MS, FASHP†, Christian C. Apfel, MD‡, Frances Chung, FRCPC§, Peter J. Davis, MD , Steve Eubanks, MD¶, Anthony Kovac, MD#, Beverly K. Philip, MD**, ` Daniel I. Sessler, MD††, James Temo, CRNA, MSN, MBA‡‡, Martin R. Tramer, MD, DPhil§§, and Mehernoor Watcha, MD
Departments of*Anesthesiology and ¶Surgery, Duke University Medical Center, Durham, North Carolina; †Departments of Pharmacy and Anesthesiology, Scott and White Memorial Hospital, Texas A&M University System HSC College of Medicine, Temple, Texas; ‡Outcomes Research™ Group and Department of Anesthesiology, University of Wuerzburg, Wuerzburg, Germany; §Department of Anesthesia, University of Toronto, Toronto,Canada; Departments of Anesthesiology and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; #Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; **Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts; ††Outcomes Research™ Institute and Departments of Anesthesiology and Pharmacology, University of Louisville,Louisville, Kentucky; ‡‡Duke University Nurse Anesthetist Program, Durham, North Carolina; §§Division of Anaesthesiology, Geneva University Hospital, Geneva, Switzerland; and Department of Anesthesia, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

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ostoperative nausea and vomiting (PONV) continues to be a common complication of surgery. It is a limiting factor in the earlydischarge of ambulatory surgery patients and is a leading cause of unanticipated hospital admission (1,2). PONV can lead to increased recovery room time, expanded nursing care, and potential hospital admission—all factors that may increase total health care costs. Equally important are the high levels of patient discomfort and
Supported by an unrestricted educational grant from Aventis, Inc. The companyhad no input into the content of this article. The following authors have conflicts of interest or potential conflicts of interest. T. J. Gan—speaker’s bureau: Pharmacia, Abbott, GlaxoSmithKline, Merck; research support: Pharmacia, Abbott, GlaxoSmithKline, Aspect, and Roche; consultant: Pharmacia, Abbott, Roche, and GlaxoSmithKline. T. Meyer—speaker: Aventis, Abbott, Baxter, and Novartis ConsumerHealth. C. C. Apfel— honoraria and research grants from AstraZeneca, GlaxoSmithKline, and Novartis. P. J. Davis— consultant: Abbott, Baxter, and GlaxoSmithKline; honorarium, Abbott, Baxter, and GlaxoSmithKline; research support: Abbott, Baxter, and GlaxoSmithKline. A. Kovac—research grant support: GlaxoWellcome, Roche Pharmaceuticals, and Hoechst Marion Roussel (now Aventis Pharmaceuticals);speaker’s bureau: GlaxoWellcome, Roche Pharmaceuticals, and Abbott Laboratories. B. K. Philip—speaking honoraria and research support: Abbott, Baxter, GlaxoSmithKline, Novartis, and Roche. M. R. Tramer— ` lecture fees: MSD and Pharmacia. M. Watcha— consultant: Baxter Pharmaceutical Products, Roche Pharmaceuticals; research support: Baxter, Abbott Laboratories, AstraZeneca, and Aspect; lectureship:GlaxoWellcome. Accepted for publication March 3, 2003. Address correspondence and reprint requests to Tong J. Gan, Department of Anesthesiology, Duke University Medical Center, Trent Drive, Durham, NC 27710. Address e-mail to gan00001@mc.duke.edu. DOI: 10.1213/01.ANE.0000068580.00245.95

dissatisfaction associated with PONV. Patients report that avoidance of PONV is of greater concern thanavoidance of postoperative pain (3) and are willing to spend up to US$100 out of pocket for an effective antiemetic (4), yet more than a quarter of patients continue to experience PONV within 24 h of surgery (5,6). Among high-risk patients, the incidence of PONV can be as frequent as 70% to 80% (7). Published evidence suggests that universal PONV prophylaxis is not cost-effective. Although some advocate...