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RONALD H. WENDER, M.D., is Co-Chair, Department of Anesthesiology, Cedars-Sinai Medical Center and Adjunct Professor and Academic Chair, Cedars-Sinai Anesthesia Residency, 8700 Beverly Blvd, Los Angeles, CA 90048 (ronaldwender{at}sbcglobal.net).

Purpose. The problem of perioperative nausea and vomiting (including postoperative and postdischarge nausea and vomiting [PONV/PDNV]) among people undergoing general anesthesia is discussed. Summary. Nausea and vomiting are not limited to the postanesthesia care unit (PACU) or the hospital, but can persist long after the patient has been discharged and has returned home. This underscores the need for new antiemetic agents that not only offer greater efficacy and proven safety, but also provide an extended duration of action. The Prospective Observational Study of Treatments, Outcomes and Patterns of Care (POSTOP), was designed to assess the impact that current antiemetic practices have on patient outcomes in the postoperative and postdischarge settings. The investigation assessed the treatments, outcomes, and patterns of care for PONV and PDNV in high-risk patients over the course of 72 hours following surgery. Based on this observational study, despite the availability of current guidelines there is no current standard of care for managing PONV and PDNV. Conclusion. Increasing the adherence to guidelines and the rational use of prophylaxis based on patient stratification will reduce the incidence of PONV, as will the development of new antiemetic agents with greater efficacies and longer durations of action that can provide extended protection from nausea and vomiting throughout the 72-hour postsurgical period. Index terms: Anesthetics; Antiemetics; Duration of action; Postoperative nausea and vomiting; Protocols; Toxicity