ERAS Cardiac logo

Postoperative Nausea and Vomiting (PONV)

Content Type: Protocols | Provider

Created: September 30, 2023
Contributor: Michael Grant, MD
Editors: Cheryl Crisafi, MSN, RN, CNL • Amanda Rea, DNP, CRNP, AGACNP-BC, CCRN, CMC, CSC, E-AEC • Gina McConnell, RN, BSN, CCRN • Shannon Crotwell, RN, BSN, CCRN • Alexander Gregory, MD, FRCPC

Summary

Postoperative nausea and vomiting (PONV) is a common complication after cardiac surgery. It can significantly reduce patient comfort, prolong hospital stay, and increase the risk of respiratory and gastrointestinal complications. In some cases, patients report nausea and vomiting as more distressing than pain.

Evidence-based strategies such as prophylactic antiemetics, multimodal pain control, early mobilization, and patient education are key to preventing PONV and supporting recovery.

Please note, logging in as a provider is required to access additional information. Click here to register for free site access or click here to login as a provider.

AI Assistance Statement

This summary was developed with assistance from artificial intelligence and reviewed, edited, and approved by the listed editor(s). Reference: OpenAI (2025). ChatGPT (November version) [Large language model]. 
https://chat.openai.com

ERAS Cardiac VEC Disclaimer

The Virtual Education Center (VEC) and all included content are intended to inform ERAS Cardiac Members on a wide range of topics related to enhanced recovery. The information presented has been provided by enhanced recovery experts and is for educational purposes only.

It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information provided is accurate or complete in every respect. Therefore, the Society is not responsible for any errors, omissions, or clinical outcomes resulting from application of the information obtained through the VEC.

All healthcare professionals should continue to exercise sound clinical judgment and base therapeutic decisions on the best available evidence and patient specific factors.

Educational materials produced by the Society for Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) may be considered Open Access. Non commercial use of ERAS Cardiac educational materials, including images, audio, and video, in whole or in part, is permitted with the following conditions:

  • The content is not altered
  • The listed authors of the content and ERAS Cardiac are appropriately referenced, and
  • A URL address or hyperlink to the original material or the main web site [https://www.erascardiac.org/] is included in the reproduction

For questions or comments about the ERAS Cardiac VEC, please contact us.

References

  1. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84(1):6-10.
  2. Mace L. An audit of post-operative nausea and vomiting, following cardiac surgery: scope of the problem. Nurs Crit Care. 2003;8(5):187-96.
  3. Sawatzky JA, Rivet M, Ariano RE, Hiebert B, Arora RC. Post-operative nausea and vomiting in the cardiac surgery population: who is at risk? Heart Lung. 2014;43(6):550
  4. Hijazi EM, Edwan H, Al-Zoubi N, Radaideh H. Incidence of Nausea and Vomiting After Fast-Track Anaesthesia for Heart Surgery. Braz J Cardiovasc Surg. 2018;33(4):371-5.
  5. Grebenik CR, Allman C. Nausea and vomiting after cardiac surgery. Br J Anaesth. 1996;77(3):356-9.
  6. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.
  7. Wang EHZ, Sunderland S, Edwards NY, Chima NS, Yarnold CH, Schwarz SKW, et al. A Single Prophylactic Dose of Ondansetron Given at Cessation of Postoperative Propofol Sedation Decreases Postoperative Nausea and Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial. Anesth Analg. 2020;131(4):1164-72.
  8. Champion S, Zieger L, Hemery C. Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study. Ann Card Anaesth. 2018 Jan-Mar;21(1):8-14.
  9. Hasheminejad E, Forner AF, Meineri M, Ender J, Zakhary WZ. Postoperative Nausea and Vomiting Prophylaxis in Fast-Track Cardiac Anesthesia: A Patient Matched Retrospective Before and After Study. International J of Anesthesiology and Pain Medicine. 2022; 8 (5): 78.
  10. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-48.