title: Evidence-based management of postoperative nausea and vomiting: a review.
abstract: OBJECTIVE
  To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).
  
  
  METHODS
  Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.
  
  
  RESULTS
  The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.
  
  
  CONCLUSIONS
  PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Habib
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D020250:Postoperative Nausea and Vomiting / Q000191:economics / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D000932:Antiemetics