What Is Postoperative Nausea and Vomiting (PONV) and Postdischarge Nausea and Vomiting (PDNV)?

PONV is nausea/vomiting within 24 hours after surgery. Nausea/vomiting within the 24–72 hour time period is called PDNV.

What Is the Incidence of PONV in Children?

Multiple studies show the incidence is about 10% in outpatient ambulatory pediatric surgery. Older studies where antiemetics were not given routinely demonstrate an incidence of PONV up to 80%. There is no published incidence in pediatric inpatients.

What Are the Risk Factors for PONV in Children?

Primary risk factors for PONV in children are:

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  Preoperative nausea and vomiting

  
  
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  Age >3 years, and especially ages 6–13

  
  
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  Surgery >30–45 minutes

  
  
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  History of PONV with previous anesthesia

  
  
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  Motion sickness

  
  
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  ENT (tympanoplasty and adenotonsillectomy)/strabismus surgery

  
  
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  Multiple doses of opioids

Why Is There a Minimal Incidence of PONV in Children under Three Years of Age?

The primary mediator of nausea/vomiting is the chemoreceptor trigger zone (CTZ) as well as the vomiting center in the medulla oblongata in the brain. The thought process is that those areas are not well developed until the age of three in humans, and therefore there is decreased susceptibility in this age group.

Is There a Multimodal PONV Model in Children? Is There a Tiered Model for PONV Based on Risk Factors?

The multimodal PONV model has not been rigorously studied in the pediatric population. Similarly, the tiered model such as the Apfel model does not have a pediatric equivalent. Given that the risk factors for adults may not translate to children, it is hard to make a recommendation at this time.