[Prevention and treatment of postoperative nausea and vomiting in children. An evidence-based approach]

Significant improvement towards an efficacious control of postoperative nausea and vomiting (PONV) has taken place recently. These improvements may be summarised using the "rule of three". That rule describes a pragmatic and rational approach of PONV control. First, identify the patient at risk using predictive factors. Second, modify the anaesthesia technique to keep the baseline risk as low as possible. Third, administer antiemetics rationally, considering their degree of efficacy, their risk, and their potential additive effects. Despite considerable research efforts, identifying the patient at high risk of PONV remains a difficult task. However, today, we understand the degree of efficacy, dose-responsiveness, and adverse effects of most antiemetics. None of those molecules should be regarded as being universally efficacious, there is no gold standard, and, when used alone, their degree of efficacy is limited. Thus, they should be combined for improved efficacy. Among the most promising molecules are butyrophenones (droperidol, haloperidol), 5-HT(3) receptor antagonists (ondansetron, dolasetron, tropisetron, granisetron), and steroids (for instance, dexamethasone). The lack of relevant paediatric PONV data remains a major drawback and is highly unsatisfactory. Hopefully, future research will further improve the control of PONV not only in adults but also in children.