Apfel PONV Score — FRCA Final MCQ

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ModerateDay SurgeryApfel PONV ScoreFRCA Final

A 45-year-old man (ASA I, 85 kg) is having an elective laparoscopic cholecystectomy as a day case. He is anxious about postoperative nausea. His Apfel score for PONV risk is 3 (female, non-smoker, history of PONV). Wait – he is male. Corrected: his Apfel score is 2 (non-smoker, history of PONV). According to the Apfel score, what is his approximate risk of PONV?

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Correct answer: B — 40%

The Apfel simplified risk score uses 4 independent predictors: (1) female sex, (2) non-smoker, (3) history of PONV/motion sickness, and (4) postoperative opioid use. Each factor adds approximately 20% to baseline risk. With 0 factors: ~10%, 1 factor: ~20%, 2 factors: ~40%, 3 factors: ~60%, 4 factors: ~80%. This patient scores 2 (non-smoker + history of PONV) = ~40% risk. Two antiemetic prophylaxis measures are recommended (e.g., ondansetron + dexamethasone). TIVA with propofol and avoidance of volatile agents also reduces PONV.

Reference: Apfel CC et al – 1999 – Simplified PONV risk score; Association of Anaesthetists – 2020 – PONV guidelines