Preoperative prevention and postoperative management of nausea and vomiting in resource limited setting: A systematic review and guideline

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Background: Postoperative nausea and vomiting is one of the common dissatisfying after surgery with a wide range of complications. It has an incidence of about 80% for patients with multiple risk factors. The etiologies of PONV are multifactorial including patient, anesthetic, and surgical factors. This review aims to support the clinical decision making of PONV management based on available evidence. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to conduct this study. PubMed, Cochrane library, and Google Scholar search engines were used to find evidence that helps to draw recommendations and conclusions. Results: In this systemic review and guideline we had used five systemic review and Meta-analysis, one guideline and 4 Meta-analysis of RCTs, three Literature reviews, three Multicenter RCTs, thirteen Single-center RCTs, and two Cross-sectional studies with their respective description of studies. Discussion: In the presence of persistent nausea and vomiting, possible contributing factors, such as patient-controlled morphine analgesia, presence of blood in the pharynx, or an abdominal obstruction, hypotension, hypoxia should be excluded before rescue therapy may be initiated. Conclusions: Patients who came for surgery have to be evaluated for the risk factors PONV and they should be categorized as low or high risk of it based on the APFEL risk score. Prevention and management of PONV should follow the flow chart as evidenced by most of the literature. Highlights:

Supports APFEL-guided PONV prophylaxis in perioperative protocols; strengthens Level 1 evidence for risk-stratified prevention.