AB272. SOH26AB_0104. Post-operative nausea and vomiting in paediatric day cases

Background: Post-operative nausea and vomiting (PONV) is common in children and can significantly delay recovery and discharge from day-case pathways. The 2016 Association of Paediatric Anaesthetists (APA) PONV guideline defines key risk factors (age >3 years, history of PONV/motion sickness, female gender, surgery type and length, use of volatile anaesthetics, use of long-acting opioids) and recommends ondansetron prophylaxis for increased-risk children and dual-agent prophylaxis for high-risk children. Rescue treatment should use an agent from a different pharmacological class. Notably, cyclizine is not recommended for established PONV in children. We assessed adherence to APA recommendations.

Methods: We performed a retrospective review of 48 paediatric day-case patients to assess adherence to APA recommendations. Data collected included demographics, surgery type, PONV risk factors, and the choice and dosing of prophylactic and rescue antiemetics.

Results: All patients had ≥1 risk factor, 15 were classified as increased risk, and 33 as high risk. Ondansetron prophylaxis was universal (48/48, 100%). Dexamethasone was administered in 29/48 cases (60.4%). Among high-risk children, 20/33 (60.6%) received the recommended dual prophylaxis, while 13/33 (39.4%) received ondansetron alone. Of the increased-risk group, 9/15 (60%) received dual prophylaxis (exceeding guideline minimum) and 6/15 (40%) received ondansetron alone. Three patients (6.3%) developed PONV in the post-anaesthesia care unit (PACU) despite appropriate prophylaxis. All received rescue therapy. However, none were treated with agents recommended by the APA for established PONV.

Conclusions: Although prophylaxis was universally provided, dual-agent cover for high-risk children and guideline-appropriate rescue therapy were inconsistent. As effective PONV prevention is crucial for timely day-case discharge, improving adherence to APA recommendations represents a clear opportunity to enhance recovery and operational efficiency.

Keywords: Ondansetron; paediatric; post-operative nausea and vomiting (PONV); prophylaxis; risk stratification