When selecting antiemetics for the prevention and management of Postoperative Nausea and Vomiting (PONV), clinicians consider various factors, including the potential for side effects, their own clinical experiences, the cost-effectiveness of the treatment, and the medication's availability. It's important to note that the research into the side effects of many antiemetics when used specifically for PONV prevention is limited; however, where relevant, specific side effects are detailed in the drug descriptions provided.
The guidelines for the use of antiemetics include:
All antiemetics come with a range of side effects, from mild to severe, including but not limited to headaches, sedation, and alterations to the electrocardiogram (ECG), particularly QT interval prolongation. Each of these side effects should be considered and tailored to the patient’s unique picture. Importantly, the effectiveness of an antiemetic is closely tied to the patient's baseline risk of experiencing PONV. Patients at a higher risk of PONV experience a more significant reduction in risk compared to those at a lower risk. For example, ondansetron can reduce the PONV risk from 80% to 60% in patients considered at high risk, whereas in lower-risk patients, the reduction might only be from 10% to 7.5%. With all of this in mind, antiemetics are acknowledged for their capacity to reduce the incidence of PONV by only approximately 25%.
