Outpatient Surgery Magazine

What About Preventing PONV?

The only shortcoming in Dr. Alan P. Marco's PONV article ("How to Fine Tune Your PONV Regimen," June, page 40) was failing to mention the possibility of using a low emetogenic anesthetic technique(1) to avoid creating the problem in the first place.

According to Dr. Marco's stratification of risk, my exclusively office-based plastic surgery practice — which is 80% female, the overwhelming majority of them non-smokers with 35% previous PONV — would be moderate to high risk. Avoiding the routine use of opioids as well as inhalation vapors, my 10-year propofol ketamine experience has had 13 emetic events in 2,680 patients or a 0.5% PONV rate without the use of any prophylactic measures Dr. Marco suggests. If a patient has had previous PONV, he is likely to be opioid sensitive. This is analogous to being a waiting bucket of gasoline. The routine use of any opioids is like the proverbial match into the gasoline. As I tell my patients, if you don't toss the match into the gasoline, you don't have to worry about which fire extinguisher(s) to use.

Barry L. Friedberg, MD
Cosmetic Surgery Anesthesia
Corona del Mar, California
drfriedberg@doctorfriedberg.com