so the last 8 patients i've had with hx PONV i've done the following:

4mg zofran prior to any other drugs, 4 at the end
8mg decadron
planning for no reversal - depending on the length of the case this either means induction with sux or a reduced dose of roc
hydration
warmth
plenty of pain control - even for short lap cases
.........and................50% nitrous with sevo on all of them.

awake extubations/LMA out

results (as reported by the PACU nurses) - no nausea.

all of these have been B&B cases (choles, hysters, etc).

i know my unofficial sample size is rediculously small so far..... some people will hurl no matter what, and require tiva, so i'm in no way claiming a 100% success rate. i just like the way my last few PONV hx cases have turned out. i'm not sure i buy nausea at 50% (all the studies i've read are 70%).

i understand the potential mechanisms of PONV with bowel expansion and inc. inner ear pressure. i'm just questioning them.

thoughts? i realize this is an age old debate. discussed many times on this forum.
i like nitrous - MTHFR be damned - or rather, ruled out preoperatively ;-)