Anaes SAQs · Anaesthetic adjuncts

Antiemetics for PONV — the four classes and the risk-stratified strategy

The Apfel four-factor risk score (female sex, non-smoker, history of PONV or motion sickness, postoperative opioids) and its risk gradient (10 to 80 per cent); the four drug classes acting at four receptors (5-HT3 antagonists, dexamethasone, droperidol, NK1 antagonists) with their signatures (ondansetron QT prolongation, droperidol black-box QT warning, dexamethasone safe and slow-onset at induction, NK1 long-acting and expensive); combination prophylaxis for moderate-to-high risk; rescue therapy with a DIFFERENT class; the multimodal opioid-sparing technique.