Drugs in anesthesia: preventing postoperative nausea and vomiting

Abstract

Purpose of review 

Postoperative nausea and vomiting (PONV) continues to be a burden for patients, medical staff and healthcare facilities because of inadequate adherence to available recommendations. This review gives an overview on recent recommendations, new evidence and remaining issues in the field of PONV management.

Recent findings 

A wide range of drugs is available for the management of PONV including corticosteroids, 5-HT₃-antagonists, dopamine-antagonists, neurokinin-receptor-1 (NK₁)-antagonists, antihistamines and anticholinergics. The updated PONV guidelines from 2020 recommend a universal multimodal strategy for PONV prophylaxis, which is an important paradigm shift to improve implementation of the existing evidence. A recent Cochrane network meta-analysis ranked single drugs and drug combinations for PONV prophylaxis in terms of efficacy and safety. Notably, NK₁-antagonists and new 5-HT₃-antagonists ranged among the most effective drugs. However, safety data on antiemetics are generally scarce.

Summary 

Numerous drug (combinations) and strategies are available for PONV management. New and very effective (single) drugs could result in a simplification compared with a combination of several drugs, and thus lead to better implementation.