Anesthesia & Clinical Research
Open Access

Abstract

Post-Operative Nausea and Vomiting (PONV) Management in Adult ENT and Maxillofacial Patients

Charlotte Binnie*, Lucy Dicks-Ilori and Khalid Hasan

Background: Post-Operative Nausea and Vomiting (PONV) is an ongoing complication for operative care teams. PONV can result in patient distress (compromising their recovery profile) and discharge delays with associated cost implications. In 2019, the University Hospitals Birmingham NHS Foundation Trust had no published guidelines addressing PONV management. Aims were to determine the percentage of patients being risk assessed for PONV; discover the true incidence of PONV in this subset of patients versus predicted risk; to determine the current practices regarding prescription of preoperative, intra-operative and post-operative anti-emetics.

Methods: This was a prospective audit utilising intra-operative physical notes and online patient documentation. An initial review made it apparent that maxillofacial and Ear, Nose and Throat (ENT) operations present a higher risk of PONV. It was decided that surgical day-case patients in these specialities provided insight into current preventative and reactive anaesthetic practices. 71 patients were randomly identified as suitable to be incorporated into this study. For the final outcome, anaesthetists were asked to respond to a short online questionnaire.

Results: This audit found that no patients had been officially risk assessed for PONV as part of their pre-operative assessment. True incidence of PONV fell below the predicted risk of PONV based on each patient’s APFEL score. 80% of patients in this study were prescribed intravenous cyclizine post-operatively.

Conclusion: Following presentation of findings to anaesthetists and surgical colleagues at the Trust, we will propose the integration of the APFEL scoring system for PONV prediction into the preoperative anaesthetic assessment proforma.

Published Date: 2022-11-04; Received Date: 2022-10-03