A female non-smoker patient is scheduled for laparoscopic gynaecological surgery under general anaesthesia with volatile agent. Using the Apfel simplified risk score, how many risk factors for PONV does she have, and what antiemetic prophylaxis is indicated?

• A 1 risk factor; no prophylaxis needed
• B 2 risk factors (female sex, use of volatile anaesthetic); 1 antiemetic
• C 4 risk factors; high risk requiring 4-drug prophylaxis and TIVA
• D 3 risk factors (female sex, non-smoker, volatile agent); 2 antiemetics recommended ✓

Explanation

The Apfel simplified PONV risk score has 4 factors: female sex, non-smoking status, history of PONV/motion sickness, and use of postoperative opioids. Volatile anaesthetic use is also a risk factor in some scoring systems. This patient has female sex + non-smoking = 2 Apfel factors (score 2), with an additional risk from volatile anaesthetic and laparoscopic gynaecological surgery. With 3 risk factors present (Apfel 2 + volatile), combination prophylaxis with at least 2 antiemetics (e.g., ondansetron + dexamethasone) is recommended per SAMBA 2020 guidelines. TIVA substitution of volatile with propofol further reduces PONV risk.

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

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Written and medically reviewed by the StethoPrep medical team.