title: Prevention and treatment of postoperative nausea and vomiting.
abstract: OBJECTIVE
  The physiology, risk factors, and prevention and treatment of postoperative nausea and vomiting (PONV) are discussed.
  
  
  CONCLUSIONS
  Factors to consider when determining a patient's risk for PONV include sex, history of PONV, history of motion sickness, smoking status, duration of anesthesia, use of opioids, and type of surgery. Receptors that, when activated, can cause nausea or vomiting or both include dopamine type 2, serotonin type 3, histamine type 1, and muscarinic cholinergic type 1 receptors. Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone. In high-risk patients, combining two or more antiemetics with different mechanisms of action has been shown to be more effective than using a single agent. In addition to administering a prophylactic antiemetic, it is important to reduce the patient's risk by considering regional anesthesia, considering inducing and maintaining general anesthesia with propofol, ensuring good intravenous hydration, avoiding hypotension, and providing effective analgesia. If PONV occurs in the immediate postoperative period, it is best treated with an antiemetic agent from a pharmacologic class different from that of the prophylactic agent.
  
  
  CONCLUSIONS
  Prophylactic antiemetic therapy for PONV is effective, but combinations of agents may be necessary for high-risk patients. Nonpharmacologic strategies are also important.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 60612-7230, USA. jgolemb@uic.edu
authors.forename: Julie
authors.initials: J
authors.lastname: Golembiewski
authors.forename: Eric
authors.initials: E
authors.lastname: Chernin
authors.forename: Tania
authors.initials: T
authors.lastname: Chopra
mesh_terms: D000932:Antiemetics / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use; D004513:Education, Pharmacy, Continuing / Q000379:methods*; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy* / Q000517:prevention & control*; D012655:Self-Evaluation Programs / Q000379:methods
chemical_list: D000932:Antiemetics