Laurie Senn

Date of Award


Document Type

Independent Study

Degree Name

Master of Science (MS)


Background: Postoperative nausea and vomiting (PONY) remain common complications following surgery and their causes and treatments are complex. Despite much research and advances in treatment, PONY is present as often as 25-30% following all surgical cases. Patients have identified avoidance of nausea and vomiting, avoidance of gagging on endotracheal tube, and control of postoperative pain as their top priorities following surgery. Certain patient characteristics, type of surgery performed, and some anesthetic medications have been implicated in increasing the risk of developing PONY. Patients at high risk for developing PONY are frequently female, have a history of PONY or motion sickness, are nonsmokers, are undergoing laparoscopic procedures, or have received intraoperative and postoperative opiates to control pain. By quickly and effectively identifying patients that are high risk for developing PONY, the CRNA can improve patient satisfaction, minimize postoperative complications and unanticipated hospital admissions, and prioritize therapy in a cost-effective manner. The purpose of this project is to create a pocket guide that can be easily utilized by anesthesia personnel to assess risk for development of PONY and an algorithm that guides decision-making for prophylactic treatment individualized to each patients associated risk .

Methodology: Following an extensive review of the literature, a risk stratification model for PONY was chosen as a screening tool for all patients undergoing surgical procedures . The number and severity of risk factors serves as a guide for the anesthesia provider in prophylactic therapy decisions for nausea and vomiting. An algorithm based on evidence and consensus, as determined by the literature, was developed. These pocket guides are designed to be used by the novice, advanced beginner, and competent nurse anesthetist. Conclusions: By having a simple handy guide that can be carried with the anesthesia provider at all times, patients can be quickly and appropriately screened and risk determined. Based upon the level of risk, decisions regarding prophylactic treatment of PONV can be made to meet patients' needs and provide cost effective care