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Postoperative nausea and vomiting (PONV) is frequently cited as the most common complication of anesthesia, and it is one that patients frequently complain about. Many drugs used in ambulatory anesthesia are potentially capable of causing nausea and vomiting, particularly the halogenated gases (isoflurane, halothane, sevoflurane) and anticholinesterases. Narcotic medications such as morphine and fentanyl may also cause nausea and vomiting, as do barbiturates. Benzodiazepine medications have not been cited as a cause of PONV, and propofol is known to have antiemetic properties.

In addition to the effects of the anesthetic drugs, there are several patient factors that are known to increase the risk of PONV. Female gender, past history of PONV or motion sickness, nonsmoking status, postoperative opioid use, and younger age [21] may all predispose toward nausea and vomiting post‐anesthesia. Dehydration may also be a factor.

Prevention is an important consideration given that PONV is a frequent cause of delayed discharge to home after ambulatory anesthesia procedures [16]. Treatment of nausea and vomiting once it occurs is more difficult and less successful than efforts at prophylaxis. Avoiding dehydration and hypoglycemia by maintaining a reasonable preoperative fasting period and giving IV fluids during surgery will benefit most patients. Avoiding volatile anesthetics and nitrous oxide, favoring the use of propofol, and limiting opioids in the postoperative period can all help prevent PONV. In addition, screening prospective patients to identify those at risk of PONV will allow the surgeon to consider pharmacological methods of nausea and vomiting prophylaxis. Several effective medications are available that can be given by mouth or intravenously in order to prevent and/or treat nausea and vomiting (see Table 1.4).

Table 1.4. Common antiemetic medications

PO: by mouth; IV: intravenous; IM: intramuscular; PR: rectal suppository.

Dolasetron, ondansetron, granisetron	5‐HT3 receptor antagonist (PO, IV); given at end of surgery
Droperidol, haloperidol	butyrophenones (IV); given at end of surgery
Aprepitant, casopitant, rolapitant	NK‐1 receptor antagonists (PO); given before surgery
Perphenazine	Phenothiazine derivative (PO, IV, IM, PR)
Dimenhydrinate, meclizine	Antihistamine (IV, PO)
Scopolamine	Anticholinergic agent (transdermal patch); given before surgery
Dexamethasone	Steroid (PO, IV, IM); given at induction