5 Post-operative nausea and vomiting

Post-operative vomiting still occurs at an unacceptably high rate in paediatric anaesthesia. Determinants of its incidence are a history of post-operative emesis and the surgical site (e.g. strabismus surgery, ENT procedures, orchidopexy). The choice of pre-medication and anaesthetic technique may also affect the risk of PONV, as may the use of opioids, gastric inflation by mask ventilation and the duration of surgery. To avoid, decrease the risk of, or alleviate the severity of PONV, it is important to realize that this is a multifactorial problem. Careful history-taking and the provision of well-balanced information for child and parents at the pre-operative visit are invaluable. Pre-medication and anaesthetic technique should be chosen with a view to minimizing the risk of PONV, for example, by using a non-opioid pre-medication, regional blocks whenever possible, and non-opioid analgesics both at the end of surgery and post-operatively. The anaesthetist should consider administering anti-emetics at an early stage, and also routinely prescribe appropriate anti-emetics for use in the post-operative period. Anti-emetics should be administered at any sign of post-operative nausea. If opioids are required post-operatively, anti-emetics could be administered at the same time. Post-operative pain is preferably controlled with non-opioid analgesics if possible. The post-operative period should be calm and without unnecessary disturbance of the child. Transport of the child should be performed carefully. Oral fluids should be suspended until asked for by the child.