Postoperative nausea and vomiting: translating pathophysiological mechanisms into clinical management

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Postoperative Nausea and Vomiting (PONV) is a common complication following general anesthesia (GA).
• Current guidelines and preventive strategies for PONV have limitations in achieving complete prevention.
• Understanding influencing factors is crucial for effective PONV management.

Purpose of the Study:

• To review the mechanisms, influencing factors (patient, surgery, anesthesia-related), and management strategies for PONV in adults under GA.
• To summarize evidence from randomized trials on PONV incidence with opioid-sparing or opioid-free anesthesia protocols.
• To provide evidence-based guidance for optimizing anesthetic management to prevent and treat PONV.

Main Methods:

• Comprehensive literature review of mechanisms, risk factors, and treatment strategies for PONV.
• Analysis of randomized controlled trials investigating opioid-sparing or opioid-free anesthesia.
• Synthesis of traditional guidelines with recent evidence and considerations.

Main Results:

• PONV is influenced by patient, surgical, and anesthetic factors.
• Pharmacological and non-pharmacological interventions are available for prevention and treatment.
• Opioid-sparing and opioid-free anesthesia protocols show promise in reducing PONV incidence.

Conclusions:

• Optimizing anesthetic management, including opioid-sparing strategies, is key to improving PONV outcomes.
• A multimodal approach integrating evidence-based and recent considerations is recommended.
• Further research and clinical application of optimized protocols can enhance patient comfort and safety post-GA.