Post-operative nausea and vomiting (PONV) has been described as the 'b
ig little problem'. With the marked improvement in anaesthetic-related
mortality and life-threatening morbidity, attention has increasingly
focused on the control of post-operative pain and emetic symptoms. Whi
le much effort has been rightly centred on attempts to reduce post-ope
rative pain, not enough attention has been given to the management of
PONV. Yet many patients consider this complication to be as debilitati
ng as the pain associated with the surgical procedure. With the advent
of newer drugs such as the anti-serotonin agents (e.g. ondansetron an
d granisetron), propofol and eltanolone, parenteral non-steroidal anti
-inflammatory agents and rapid, shorter-acting neuromuscular blocking
drugs that do not require routine antagonism, the incidence of emesis
has been decreased. Abolition of the requirement that patients drink l
iquids prior to discharge from the ambulatory care centre has also hel
ped to reduce PONV.