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Treating PONV


  • Treatment options are the same drugs described previously  

  • If prophylaxis was used → use a drug from another class to treat PONV 

    • Repeating the medication given for PONV prophylaxis within the first 6 hours after the initial dose conferred no additional benefit. 

  • If NO prophylaxis was given → start with a low dose 5-HT3 antagonist (e.g. Ondansetron 1mg) 

    • The 5-HT3 antagonists are the only drugs that have been adequately studied for the treatment of existing PONV. 

  • Alternative treatments for established PONV include:

    • Dexamethasone, 2 to 4 mg IV

    • Droperidol, 0.625 mg IV, or promethazine 6.25 mg IV

    • Propofol, 20 mg as needed, can be considered for rescue therapy in patients still in the PACU & is as effective as ondansetron. 



Adapted from Anesth Analg. August 2020 - Volume 131 - Issue 2 - p 411-448

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