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ROBERT J. IGNOFFO, PHARM.D., FASHP, FCSHP, is Professor, Touro University, and Clinical Professor Emeritus, University of California at San Francisco, 521 Parnassus Avenue, UCSF Box 0622, Room C-152, San Francisco, CA 94143 (ignoffob{at}pharmacy.ucsf.edu).

Purpose. Guidelines have been constructed to optimize the management of patients at risk of developing postoperative nausea and vomiting or postdischarge nausea and vomiting (PONV/PDNV), including the 2002 American Society of Anesthesiologists (ASA) recommendations, the 2006 guidelines assembled by an American Society of PeriAnesthesia Nurses task force (ASPAN), and another set published in 2007 with the support of the Society for Ambulatory Anesthesia (SAMBA). The recommendations set forth are reviewed. Summary. Patient risk factors have been identified that are associated with higher incidences of PONV. For prophylaxis of PONV in high-risk patients, combinational and multimodal therapies with as many as three interventions, including a 5-HT3-based therapy and other antiemetic agents with different mechanisms of action, were advocated by guidelines and systematic reviews; specific pharmacotherapies and other interventions were recommended, as well as a treatment algorithm. The number of antiemetic agents prescribed should be appropriate for the individual’s risk level, once again emphasizing the importance of patient risk stratification. Prophylaxis for PONV should be maintained throughout the period of risk. Conclusion. Evidence from the Prospective Observational Study of Treatments, Outcomes, and Patterns of Care study indicates that the use of guideline recommended PONV and PDNV prophylactic treatments leads to improved outcomes. Index terms: Antiemetics; Mechanism of action; Postoperative nausea and vomiting; Protocols