Clinical utility of antiemetics and complementary therapies in the prevention of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) is a persistent problem in perianesthesia practice. Approximately 30% of patients receiving anesthesia will experience this complication, which can increase patient dissatisfaction, increase costs, and in some patients precipitate other postoperative complications. During the last three decades, there has been increasing interest and research on best practices to diminish the incidence of this clinical problem, as patient satisfaction is linked to PONV guideline use. Some institutions have low incident rates because of consistent protocol use, and new medication classifications and multiple complementary therapies have been incorporated into daily use. There are several clinically useful guidelines and algorithms used to guide primary prevention strategies, as discussed in this review. However, severe PONV continues to be refractory to available interventions, and the best hope for elimination of this complication may arise from pharmacogenomics. Keywords: postoperative nausea and vomiting, postanesthesia complications, clinical practice guidelines, pharmacology