New antiemetic drugs.

In an editorial, Kapur [4] described perioperative nausea and vomiting as the big "little problem following ambulatory surgery." In contrast to the attitudes of some physicians, patients put a high value on freedom from nausea and emesis in the postoperative period and are willing to accept some pain and drowsiness as the cost of controlling PONV [85]. Until recently, there had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, the introduction of the IV anesthetic agent propofol and of the NSAID ketorolac, plus abandonment of the policy of insisting that patients drink before discharge, appear to have contributed to a recent decline in the incidence of emesis. With the availability of new antiserotonin drugs, the incidence of recurrent (intractable) emesis could be further decreased, particularly if combination therapy is used. Further research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. Improvements in antiemetic therapy could have a major impact for surgical patients, particularly those undergoing ambulatory surgery. Just as pain is no longer considered an unavoidable part of the postoperative experience, so should nausea and vomiting be considered an avoidable side effect.