Postoperative nausea and vomiting (PONV) is a patient-important outcome; patients often rate PONV as worse than postoperative pain [ 1 ]. The duration of anaesthesia, which is closely linked to the duration of surgery, can help predict the patient's risk of PONV, since the duration of anaesthesia describes the patient's exposure to emetogenic stimuli like volatile anaesthetics and intraoperative opioids. Are there other factors contributing to nausea? About 33% of all people undergoing surgery, and 70% of people identified as high risk, will suffer this side effect of anesthesia. If the stimuli are sufficient, it acts on the diaphragm, stomach and abdominal musculature to initiate vomiting. Metoclopramide is a widely used D2 antagonist. Any higher cortical input, as previously discussed, should be treated appropriately, so ensure patient is well-hydrated, any pain is well controlled, and anxiety is treated appropriately. A wide variety of pharmacological options are available for anti-emetic action and it is important that the choice of antiemetic is considered by the likely cause of the nausea. When 0, 1, 2, 3, or 4 risk factors are present, the incidence of POV is 9%, 10%, 30%, 55%, or 70%, respectively. The use of supplemental oxygen (: 80%) does not reduce the incidence of PONV. Consider the following questions during your assessment of the patient: In addition, it is important to be aware of alternative causes of nausea and vomiting in the post-operative patient, such as infection, gastrointestinal causes (post-operative ileus, bowel obstruction), metabolic causes (hypercalcaemia, uraemia, DKA), medication (antibiotics, opioids), CNS causes (raised ICP), or psychiatric causes (anxiety). It affects approximately 20-30% patients within the first 24-48 hours post-surgery. If in any doubt, an ABCDE approach should be taken. Due to the models' inherent limitations in accuracy, however, prophylactic therapy should be administered to patients according to their predicted risk of PONV or the number of risk factors they have, as is done for the prevention of conditions like post-surgical venous thromboembolism (Fig. transdermal scopolamine). Enterochromaffin cells in the gastrointestinal tract release serotonin, and the vagus nerve communicates with the CRTZ via 5-HT3 receptors. The consequences of PONV can include increased anxiety for future surgical procedures, increased recovery time and hospital stay, and, in severe cases, aspiration pneumonia, incisional hernia or suture dehiscence, bleeding, oesophageal rupture, and metabolic alkalosis. 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