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Multimodal PONV Prophylaxis Apfel Score — FRCA Final MCQ

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ModerateDay SurgeryMultimodal PONV Prophylaxis Apfel ScoreFRCA Final

A 45-year-old woman (ASA I) undergoes a knee arthroscopy as a day case. She vomits once in recovery. Her Apfel PONV risk score was 3. According to enhanced recovery principles, which COMBINATION of prophylactic antiemetics should she have received?

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Correct answer: E — Metoclopramide only

PONV prophylaxis should be matched to the patient's Apfel risk score: Score 0-1 (low risk): no routine prophylaxis; Score 2 (moderate): 1-2 antiemetics; Score 3-4 (high risk): ≥2-3 antiemetics from different classes PLUS consider TIVA. Effective combinations include: ondansetron (5-HT3 antagonist) + dexamethasone (corticosteroid, given at induction) ± cyclizine/droperidol + TIVA (propofol reduces PONV). A multimodal approach is most effective.

Reference: Association of Anaesthetists – 2020 – PONV guidelines; BADS – 2019 – Day surgery