A 34-year-old woman undergoes laparoscopic gynaecological surgery under general anaesthesia. She is a non-smoker, has a history of PONV, does not use opioids postoperatively, and received volatile anaesthesia. Using the Apfel score, what is her risk of PONV?

• A 10% — Apfel score 1
• B 40% — Apfel score 2
• C 79% — Apfel score 4
• D 61% — Apfel score 3 ✓

Explanation

The Apfel simplified risk score assigns 1 point each for: female sex, non-smoking status, history of PONV or motion sickness, and postoperative opioid use. This patient scores 3 (female + non-smoker + prior PONV = 3 factors; opioid use is absent). An Apfel score of 3 corresponds to approximately 61% PONV risk. At 3–4 risk factors, combination prophylaxis with two to three antiemetics from different classes is indicated (ondansetron + dexamethasone ± droperidol/scopolamine), and TIVA with propofol should be considered instead of volatile anaesthesia.

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

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