OBJECTIVE: Postoperative nausea and vomiting (PONV) still represent an important 
problem in surgery. Treatment and prevention of PONV requires accurate risk 
stratification. The simplified Apfel-score includes the four factors female 
gender, no smoking, postoperative use of opioides and previous PONV or 
motion-sickness in patients' history. Each of these risk factors is supposed to 
elevate the PONV-incidence about 20%. The aim of the study was to validate this 
clinical risk assessment score in patients with high risk for PONV.
METHODS: In a prospective study 93 patients with high risk preoperative score 
for PONV (Apfel Score III and IV) were analyzed. Patients and nurses were 
interviewed using a standardized questionnaire at the time of discharge from the 
post-anesthesia care unit (PACU) as well as 6 hours and 24 hours after admission 
to the PACU. General anaesthesia was applied as total intravenous anaesthesia 
(TIVA) with mivacurium, propofol and remifentanil (no nitrous oxide / FI 02 0.5)
RESULTS: In the group with Apfel score III PONV occurred in 59.7% of patients 
and in the Apfel score group IV in 91.3% of all patients. The incidence of PONV 
corresponds to the predicted values of 60% for Apfel III and 80% for Apfel IV 
although the use of TIVA should have reduced the incidence of PONV about 26%. 
This apparent overestimation could be explained by the frequent questioning of 
patients and nurses for PONV leading to assessment of very minor symptoms.
CONCLUSION: The Apfel-score is a useful and simple tool for stratification of 
patients with high risk for PONV.