How should the pharmacological management of PONV be approached postoperatively?

  • Administer an antiemetic from a different pharmacologic class from the prophylactic drugs initially given
    • If no prophylaxis is given, first-line is recommended as a low-dose 5-HT3 antagonist
    • Other options include dexamethasone or promethazine / cyclizine
    • Haloperidol should only be used for adults
    • Droperidol should only be in children if other options have failed
    • Propofol 20mg may be considered as a useful rescue therapy
  • Drugs should only be readministered if > 6 hours postoperative:
    • Dexamethasone and scopolamine should not be readministered
Consensus Guidelines

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