Postoperative nausea and vomiting--can it be eliminated?

POSTOPERATIVE NAUSEA AND VOMiting (PONV) frequently complicates recovery from surgery. Before the 1960s, when older inhalational anesthetic agents such as ether and cyclopropane were widely used, the incidence of vomiting was as high as 60%. Better anesthetic techniques, along with a new generation of antiemetics and shorter-acting anesthetic drugs, have reduced the overall incidence of PONV to approximately 30%. However, PONV occurs in as many as 70% of high-risk patients, and pediatric populations are not spared. Although the overall incidence may be lower in children younger than 2 years, procedures such as tonsillectomies and strabismus surgery have a PONV incidence as high as 60%. Ambulatory patients appear to have a lower incidence of PONV compared with inpatients, but this incidence may be related to underrecognition of postdischarge nausea and vomiting. Although PONV is rarely fatal, it is an unpleasant postoperative symptom (BOX). Even mild PONV can delay hospital discharge, decrease patient satisfaction, and increase use of resources. Avoiding PONV is important to patients, more so than avoiding postoperative pain. In one study, patients were willing to spend up to $100, at their own expense, for an effective antiemetic.