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Postoperative nausea and vomiting is a nuisance. The anaesthetist is usually blamed, despite evidence that postoperative nausea and vomiting results from several factors, some related to anaesthesia, others to surgery, and some to the patients themselves.
The importance of postoperative nausea and vomiting is generally underestimated because it is self limiting, never becomes chronic, and almost never kills. However, its impact on the cost of health care is not negligible. Surgical patients prefer to suffer pain rather than postoperative nausea and vomiting 3 and would be willing to pay considerable amounts of money for an effective antiemetic. A major obstacle to the development of an effective treatment has been the lack of a valid animal model for postoperative nausea and vomiting.
New insights into pathways for emesis and efficacy of antiemetics have come from animal research with highly emetogenic chemotherapy. Extrapolation of these data to postoperative nausea and vomiting has been of limited value. Anaesthetists therefore have to rely on the results of a myriad of clinical trials, most of small size and some of doubtful validity.
Data on an almost infinite number of potentially useful antiemetic interventions have been published during the last 40 years. Despite this large body of literature fundamental data on dose responsiveness or profiles of adverse effects have remained unclear for most antiemetics, and no agreement has been reached on what constitutes a gold standard. As a consequence, anaesthetists have been using antiemetics irrationally.
The good news is that notable progress towards improved control of postoperative nausea and vomiting has been achieved during recent years. The first landmark was the advent of several sponsored, high quality, dose finding studies of a 5-hydroxytryptamine 3 receptor antagonist, ondansetron, in the early s.