title: Pharmacologic management of postoperative nausea and vomiting.
abstract: BACKGROUND
  As advances in the safety and efficacy of surgery and anesthesia have been made, other complications such as postoperative nausea and vomiting (PONV) have become more apparent. PONV occurs after 30% of all surgeries, and incidences as high as 80% have been reported among patients at high risk.
  
  
  METHODS
  This review provides a brief overview of the etiology and mechanisms of emesis and of known risk factors for PONV. It also covers pharmacologic therapies, appropriate management strategies, prophylactic strategies, multimodal therapy and rescue treatment.
  
  
  CONCLUSIONS
  The main triggers for PONV are general anesthesia with inhalational anesthetics and opioids. When given to susceptible patients, e.g., females, the risk may be as high as 80%. In such patients, opioid-free regional anesthesia would be the most logical approach. However, if general anesthesia is needed, we prefer total intravenous anesthesia as it eliminates the use of inhalational anesthetics and reduces the risk for PONV. Importantly, efficacy of antiemetic interventions is independent as long as interventions have different mechanisms. Thus, for practical purposes, we prefer to titrate the use of antiemetics according to the validated Apfel simplified risk score. If a patient has 0, 1, 2, 3 or 4 of the four risk factors, we apply a similar number of antiemetic strategies.
authors.affiliation: University of California, UCSF Medical Center , Department of Anesthesia and Perioperative Care, Mount Zion Campus, 1600 Divisadero, C-447, San Francisco, CA 94115, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Fero
authors.forename: Leena
authors.initials: L
authors.lastname: Jalota
authors.forename: Cyrill
authors.initials: C
authors.lastname: Hornuss
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000932:Antiemetics