A 35-year-old non-smoking female with a history of motion sickness and PONV receives a 90-minute laparoscopic gynaecological procedure under volatile anaesthetic. According to the Apfel simplified PONV score, how many risk factors does she have, and what prophylaxis strategy is recommended?

• A 2 risk factors; single antiemetic prophylaxis
• B 3 risk factors; dual antiemetic therapy and consider TIVA
• C 4 risk factors; triple antiemetic prophylaxis and TIVA ✓
• D 3 risk factors; no specific prophylaxis needed, treat symptomatically

Explanation

The Apfel simplified PONV risk score assigns one point each for: female sex, non-smoker, history of motion sickness or PONV, and postoperative opioid use. This patient scores: female (+1), non-smoker (+1), history of PONV/motion sickness (+1) = 3 risk factors minimum; if opioids are anticipated postoperatively, the score is 4. Laparoscopic gynaecological surgery and volatile anaesthetics are additional triggers. With ≥3 Apfel points, multimodal dual-to-triple antiemetic prophylaxis (e.g., ondansetron + dexamethasone ± droperidol/scopolamine) and preferably TIVA (propofol infusion) are recommended to minimise baseline emetogenic risk.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.