Postoperative nausea and vomiting (
PONV), a common complication after
anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat
PONV, it is important to understand the factors implicated in
PONV, the mechanisms of
PONV, the pharmacology of the
antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of
PONV is likely to be multifactorial, with important predictors being female gender, history of
PONV, and history of
motion sickness. The
vomiting center can be triggered by activation of
dopamine,
serotonin (type 3),
histamine (type 1), and
muscarinic cholingergic receptors in the chemoreceptor trigger zone and the nucleus tractus solitarus, as well as
acetylcholine receptors in the vestibular apparatus, vagal afferents from the periphery, and the endocrine environment.
Antiemetic agents such as the
serotonin antagonists (eg,
ondansetron,
dolasetron),
droperidol,
antihistamines (eg,
diphenhydramine,
dimenhydrinate), and
promethazine can prevent and treat
PONV effectively. Transdermal
scopolamine and
dexamethasone have a role in the prevention of
PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure,
acupressure techniques, trancutaneous
acupoint stimulation, and
isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of
PONV in adults is presented.