PONV which stands for Post Operative Nausea and Vomiting, is still a common occurrence following surgery. PONV is one of the complex and significant problems in anesthesia practice, with a growing trend toward ambulatory and day surgeries.  PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. 

PONV is the second most common complaint, after pain being the primary. It remains a significant problem in modern anesthetic practice because of the adverse consequences such as delayed recovery, unexpected hospital admission, delayed return to work of ambulatory patients, pulmonary aspiration, wound dehiscence, and dehydration. In light of increased  demand for ambulatory surgery, a holistic approach should be attempted before and during surgery to prevent it. 

The goal of PONV prophylaxis is to decrease the incidence of it and thereby reducing patient-related distress and health care costs. The etiology of PONV is multifactorial and Universal PONV prophylaxis is not cost-effective. Identifying patients at high risk of PONV allows targeting prophylaxis to those who will benefit most from it. Prophylaxis is not needed for patients at low risk for PONV. And patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. 

Patients at high risk for PONV may have double and triple antiemetic combinations considered. A multimodal approach may be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost effective approach to the management of PONV will be different  between an ambulatory and outpatient surgery center 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. Identifying the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including non pharmacologic approaches; recommend strategies for treatment of PONV when it occurs; and providing  an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

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