The management of postoperative nausea and vomiting: current thoughts and protocols

Aesthetic Plast Surg. 2013 Jun;37(3):625-33. doi: 10.1007/s00266-013-0067-7. Epub 2013 Mar 14.


The postoperative course of surgical patients can have a tremendous impact on the surgical outcome and on patient satisfaction. One of the most significant issues is postoperative nausea and vomiting (PONV) which, despite being a common side effect of general anesthesia, has received little attention in the plastic surgery literature. The incidence and potential consequences of PONV are frequently underestimated and consequently the need for prophylaxis is often overlooked. There are significant consequences to this seemingly minor morbidity that extend beyond patient discomfort and dissatisfaction. In addition to being considered a significant undesirable outcome by patients, severe cases of PONV may result in postoperative complications and unplanned hospital admissions. In this article we overview the mechanism, pathophysiology, and risk factors for PONV and provide a comprehensive algorithmic approach to its management.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Publication types

  • Review

MeSH terms

  • Antiemetics / therapeutic use
  • Cholinergic Antagonists / therapeutic use
  • Dexamethasone / therapeutic use
  • Humans
  • Postoperative Nausea and Vomiting / complications
  • Postoperative Nausea and Vomiting / epidemiology
  • Postoperative Nausea and Vomiting / physiopathology
  • Postoperative Nausea and Vomiting / therapy*
  • Risk Factors
  • Serotonin Antagonists / therapeutic use


  • Antiemetics
  • Cholinergic Antagonists
  • Serotonin Antagonists
  • Dexamethasone