The definition of postoperative nausea and vomiting (PONV) is typically defined as any nausea, vomiting, or retching occurring during the first 24-48 hours after surgery. PONV is associated with increased morbidity and mortality, increased hospital costs, and decreased patient satisfaction. Patient satisfaction is an important hospital quality metric indicator. Up to 80% of patients experience PONV. Anesthesia providers can administer medications that antagonize various receptors to help prevent PONV (Dopamine 2, NK-1, Muscarinic, 5-HT-3, and Histamine 1). The 2020 Fourth Consensus Guidelines are a comprehensive and evidence-based set of guidelines for PONV management. According to the Fourth Consensus Guidelines, risk factors for PONV include females, age < 50, non-smokers, post-operative opioid use, use of volatile anesthetics and/or nitrous oxide, gynecological procedures, and laparoscopic procedures. Patients with 1-2 risk factors should receive 2 anti-emetics and those with >2 risk factors should receive 3-4 anti-emetics. A mid-Michigan teaching hospital has inconsistent practice compliance with their PONV management protocol. The PONV protocol is also inconsistent with the 2020 Forth Consensus Guidelines.
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