The meta-analysis by Fernandez-Guisa-sola et al. [1] found that the omission of nitrous oxide significantly reduced postoperative nausea and vomiting (PONV): pooled relative risk 0.80, 95% CI 0.71-0.90, p = 0.0003. The ability to predict risk is necessary to reduce PONV rates; however, anaesthetists' subjective patient assessment may not be accurate.During a prospective audit in our hospital, we evaluated the anaesthetist's subjective risk assessment relative to the risk stratification system proposed by Apfel et al. [2]. This model identifies four primary risk factors during inhala-tional anaesthesia: female sex, nonsmoking status, a history of PONV or motion sickness and opioid use. The Apfel model, using four risk factors, predicted PONV risk across groups of patients without loss of discriminating power [2, 3].
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