Post-operative nausea and vomiting (PONV) is one of the most common and distressing complications following anesthesia and surgery. Although often perceived as a minor issue, PONV can significantly impact patient comfort, delay recovery, prolong hospital stay, and increase the risk of serious complications such as dehydration, electrolyte imbalance, wound dehiscence, aspiration, and unplanned hospital admission. Effective identification and management of PONV risk is therefore a key component of safe anesthesia care.

PONV risk is influenced by a combination of patient-related, anesthesia-related, and surgical factors. Common patient risk factors include female gender, non-smoking status, history of motion sickness or previous PONV, and younger age. Anesthetic contributors include the use of volatile anesthetic agents, nitrous oxide, and opioid-based pain management. Certain surgical procedures, particularly abdominal, gynecological, ENT, and laparoscopic surgeries, are associated with a higher incidence of PONV.

Anesthesia teams perform structured risk assessment prior to surgery to identify patients at increased risk. This allows proactive implementation of preventive strategies rather than reactive treatment after symptoms occur. Prevention is far more effective than rescue therapy and improves patient satisfaction significantly.

Modern anesthesia practice emphasizes multimodal PONV prevention. This includes careful selection of anesthetic drugs, minimizing opioid use through regional anesthesia and non-opioid analgesics, and administering prophylactic antiemetic medications based on individual risk level. Total intravenous anesthesia (TIVA) may be preferred in high-risk patients to reduce exposure to inhalational agents associated with nausea.

In the postoperative period, early recognition and prompt treatment of nausea and vomiting are essential. Persistent vomiting can lead to dehydration, delayed oral intake, and delayed discharge, particularly in day-care surgeries. Adequate hydration, pain control, and early mobilization contribute to reducing PONV severity.

High-risk populations such as elderly patients, pediatric patients, and those undergoing day-care procedures require particular attention, as PONV can compromise recovery and safety after discharge. Effective counseling and clear post-discharge instructions further reduce complications.

Through structured risk assessment, preventive strategies, and timely management, anesthesia teams play a vital role in minimizing PONV and enhancing overall surgical recovery and patient experience.