Risk factors for postoperative nausea and vomiting and a basic multimodal prophylaxis plan?

Risk factors for postoperative nausea and vomiting and a basic multimodal prophylaxis plan?

• A. Male sex, history of motion sickness, smoker; prophylaxis with dexamethasone, ondansetron, scopolamine patch, and minimize opioids.
• B. Female sex, history of motion sickness, non-smoker; prophylaxis with dexamethasone, ondansetron, scopolamine patch, and minimize opioids.
• C. Female sex, history of motion sickness, non-smoker; prophylaxis with antibiotics.
• D. Low-dose opioids only.

Answer: (B)

Postoperative nausea and vomiting risk rises with certain patient factors, especially in individuals who are female, have a history of motion sickness or prior PONV, and are non-smokers. When these risk factors are present, a proactive, multimodal prevention strategy is important to cover multiple nausea pathways. The chosen plan combines different antiemetic mechanisms: dexamethasone helps reduce inflammation and central nausea signaling, ondansetron blocks serotonin receptors involved in triggering vomiting, and a scopolamine patch provides continuous anticholinergic protection against vestibular and autonomic triggers. Pairing this with minimizing opioid use further lowers nausea stimuli, since opioids can worsen PONV. This combination aligns with the highest-yield approach for someone with multiple risk factors. Antibiotics won’t prevent PONV, and relying on low-dose opioids alone would not adequately prevent it and may even increase risk.

Postoperative nausea and vomiting risk rises with certain patient factors, especially in individuals who are female, have a history of motion sickness or prior PONV, and are non-smokers. When these risk factors are present, a proactive, multimodal prevention strategy is important to cover multiple nausea pathways. The chosen plan combines different antiemetic mechanisms: dexamethasone helps reduce inflammation and central nausea signaling, ondansetron blocks serotonin receptors involved in triggering vomiting, and a scopolamine patch provides continuous anticholinergic protection against vestibular and autonomic triggers. Pairing this with minimizing opioid use further lowers nausea stimuli, since opioids can worsen PONV. This combination aligns with the highest-yield approach for someone with multiple risk factors. Antibiotics won’t prevent PONV, and relying on low-dose opioids alone would not adequately prevent it and may even increase risk.