Table 5 Anti-emetic protocols for major intra-abdominal surgery ERAS care pathways included in the IMPAKT ERAS trial at Vanderbilt University Medical Center

Pre and Intraoperative Strategies:

 • Number of PONV prophylaxis agents should equal the number of Apfel Risk Factors

 • Avoid use of volatile agents: Total Intravenous Anesthesia (TIVA) with propofol is preferred

 • Intraoperative Pharmacologic Agents:

  Dexamethasone: 8 mg IV after induction unless given in TAP blocks

  Ondansetron: 4 mg IV given 30 min prior to emergence

  Haloperidol: 1 mg IV given during skin closure, reduce to 0.5 mg IV in patients > 65 years

Postoperative Pharmacologic Agents:

 Ondansetron: 4 mg IV/PO q 6 h PRN (write:1st line for nausea and vomiting)

 Haloperidol: 0.5 – 1 mg IV PRN q 4–6 h PRN (write: 2nd line after ondansetron)

 Scopolamine patch (write: 3rd line option only if active PONV despite above)

 Promethazine: 6.25–12.5 mg IV/PO q 4 h PRN (write: 4^th line option)