One of the most common fears patients have before surgery is, “Will the anesthesia make me nauseated?

The answer is, “Possibly.”  The anesthesia medical literature contains thousands of published papers studying the science behind post-operative nausea and vomiting (PONV), and the best strategies to prevent it.

The four traits that have been found to best correlate with PONV are:

  1. female gender,
  2. a patient that does not smoke tobacco,
  3. a patient with a past history of PONV or motion sickness, and
  4. the use of postoperative intravenous narcotic pain relievers.

When 0, 1, 2, 3, or 4 of these factors are present, the risk for PONV is about 10%, 20%, 40%, 60%, or 80%, respectively.

If you are a woman smoker with a past history of nausea after anesthesia, and you are scheduled for a painful surgery that will require narcotic pain relievers, you have an 80% chance of having nausea after surgery.

If you are a man who smokes cigarettes, who has never been nauseated with past anesthetics, and your surgery is a trivial pain-free procedure on your finger, you have only a 10% chance of having nausea after surgery.

Overall, 20% to 30% of patients will experience nausea after surgery.  Nausea is the second most common complaint after surgery—pain is the most common complaint.

Anesthesia professionals typically give anti-nausea medications intravenously as prophylactic premedications to appropriate patients.  These medications may include combinations of ondansetron (Zofran), metoclopramide (Reglan), and/or dexamethasone (Decadron).

The onset time for PONV is usually in the first hour after awakening, during the time that the patient is observed in the Post Anesthesia Care Unit, or Recovery Room.  PONV can then be treated by additional rescue intravenous injections of potent anti-nausea medications such as promethazine (Phenergan).

Less commonly, patients who are discharged home the same day after surgery will have the onset of nausea either during the car ride home or when they begin their doses of oral narcotic pain relievers such as Vicodin.  Outpatient anti-nausea medications may be prescribed, including oral ondansetron (Zofran) or rectal suppositories of promethazine (Phenergan).

Of the four traits listed above that are associated with PONV, the anesthesiologist can do nothing to change the first three traits on any given patient.

However, the fourth trait can be manipulated.  The anesthesiologist and surgeon can make choices to minimize the need for postoperative intravenous narcotic pain relievers.  For certain procedures such as inguinal hernia repairs, bunionectomies, nasal surgeries, knee arthroscopies or breast biopsies, surgeons can inject local anesthetics into the surgical field to blunt post-operative pain.  For surgeries below the waist, anesthesiologists can utilize local anesthesia blocks such as spinal anesthesia or epidural anesthesia to blunt post-operative pain. For surgeries on a leg or an arm, anesthesiologists can utilize regional anesthetic nerve blocks to numb the leg or arm to blunt post-operative pain.

PONV can be such an negative experience that patients often rate it worse than postoperative pain.  Well-designed studies have shown that the amount of money that patients are “willing to pay out of pocket” for effective anti-nausea treatment of PONV is $56 per patient in the United States.  The prevention of PONV in high-risk patients significantly improves their ratings of well-being and satisfaction after surgery.

Discuss the prevention of PONV with your anesthesia professional prior to your surgery.  He or she will inform you of your risk, and the best approach to minimize your nausea after surgery.





Introducing …,  THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel. Publication date August 31, 2014 by Pegasus Books. Available on all major online book vendors.  THE DOCTOR AND MR. DYLAN can be ordered in print or ebook from The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book cover image below:

Brief description: Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.

Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.



Bang-Up Debut Novel, November 16, 2014

By Norm Goldman “Publisher & Editor of Bookpleasures”


This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.

This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.



allan mishra

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.



  1. Brown

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

I read this in hardcopy and loved it. A good well balanced novel. Characters and a story that I enjoyed and remember more than a month later. Got the book on a Saturday, and stayed up late on Monday to finish it. I rarely am so gripped by a book that I make the time to finish it that quickly.

It has some nice and unexpected plot twists, and an unusual mix of characters.

You’ll enjoy it.


Fun read. I could not put it down, November 18, 2014



This review is from: The Doctor and Mr. Dylan (Paperback)

Fun read. I could not put it down. Loved knowing a bay area doctor wrote this novel.

Five Stars, November 20, 2014


Kim (Portola Valley, CA USA)

This review is from: The Doctor and Mr. Dylan (Paperback)

Fun read, well written and highly recommend!

Learn more about Rick Novak’s fiction writing at


  1. thank you for your informative posts ! my facebook group occasionally asks what the procedures are for a pregnant post-posterior decompression surgery mother. and the complications of an epidural in pre-surg. chiari malformation.. thank you !

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