Multiple Case Study: The Overview of Post-Operative Nausea and Vomiting (PONV) In Post General Anesthesia Patients with Koivuranta Score at Tk. II Udayana Hospital
Keywords:
general anesthesia, koivuranta score, postoperative nausea and vomiting, risk assessmentAbstract
Background: Post-Operative Nausea and Vomiting (PONV) is the most frequent complication following general anesthesia. A preliminary study at TK. II Udayana Hospital recorded 1,144 patients undergoing surgery under general anesthesia between January and October 2025; however, a PONV risk assessment utilizing the Koivuranta score has never been conducted. Objective: This study aims to determine the profile of PONV in post-general anesthesia patients using the Koivuranta score at TK. II Udayana Hospital. Methods: A qualitative descriptive design with a multiple case study approach was employed involving five participants selected via purposive sampling. Data were collected through in-depth interviews, observations, and documentary studies, and subsequently analyzed using single-case and cross-case analysis. Results: All participants were female, aged 22–50 years, classified as ASA II, and underwent breast tumor excision under general anesthesia using the Laryngeal Mask Airway (LMA) technique. Four participants obtained a Koivuranta score of 3 (moderate risk), and one participant scored 4 (severe risk) due to a history of motion sickness. All participants experienced PONV in the recovery room; those with a score of 3 developed moderate PONV (scale 2) with an onset at the 30th minute, whereas the participant with a score of 4 experienced severe PONV (scale 3) with an onset at the 23rd minute. All participants received 4 mg of intravenous ondansetron. Conclusion: The Koivuranta score accurately predicts the occurrence and severity gradient of PONV. Therefore, its routine implementation in pre-anesthesia assessments is highly recommended as a baseline for administering antiemetic prophylaxis at TK. II Udayana Hospital.
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