Postoperative nausea and vomiting (PONV) are common complications following surgery, occurring after general, regional, or local anesthesia. Nausea is a subjective feeling of discomfort with the urge to vomit, while vomiting is the forceful expulsion of gastric contents. PONV can result from nonanesthetic factors such as age, gender, obesity, history of motion sickness, anxiety, and gastroparesis, as well as anesthetic factors like preanesthetic medication, gastric distension, anesthetic techniques, and postoperative factors such as pain, dizziness, and opioid use. The physiologic basis of PONV involves the emetic center in the brainstem, which is influenced by various receptors and stimuli, including the chemoreceptor trigger zone (CTZ). Anesthetic techniques, such as general anesthesia with nitrous oxide, inhalation agents, etomidate, ketamine, and propofol, can increase the risk of PONV. Regional anesthesia and monitored anesthesia care (MAC) are associated with lower rates of PONV. Postoperative factors like pain, dizziness, ambulation, oral intake, and opioid use also contribute to PONV. Prevention and treatment of PONV include antiemetic drugs such as phenothiazines, butyrophenones, antihistamines, anticholinergics, benzamides, serotonin antagonists, and combination therapies. Nonpharmacologic approaches like acupuncture and acupressure may also be effective. Antiemetic drugs target different receptor sites, with some being more effective than others. While routine antiemetic prophylaxis is not always necessary, it may be beneficial for high-risk patients. The choice of antiemetic depends on the patient's condition and the type of surgery. Overall, understanding the causes and mechanisms of PONV is essential for effective prevention and treatment.Postoperative nausea and vomiting (PONV) are common complications following surgery, occurring after general, regional, or local anesthesia. Nausea is a subjective feeling of discomfort with the urge to vomit, while vomiting is the forceful expulsion of gastric contents. PONV can result from nonanesthetic factors such as age, gender, obesity, history of motion sickness, anxiety, and gastroparesis, as well as anesthetic factors like preanesthetic medication, gastric distension, anesthetic techniques, and postoperative factors such as pain, dizziness, and opioid use. The physiologic basis of PONV involves the emetic center in the brainstem, which is influenced by various receptors and stimuli, including the chemoreceptor trigger zone (CTZ). Anesthetic techniques, such as general anesthesia with nitrous oxide, inhalation agents, etomidate, ketamine, and propofol, can increase the risk of PONV. Regional anesthesia and monitored anesthesia care (MAC) are associated with lower rates of PONV. Postoperative factors like pain, dizziness, ambulation, oral intake, and opioid use also contribute to PONV. Prevention and treatment of PONV include antiemetic drugs such as phenothiazines, butyrophenones, antihistamines, anticholinergics, benzamides, serotonin antagonists, and combination therapies. Nonpharmacologic approaches like acupuncture and acupressure may also be effective. Antiemetic drugs target different receptor sites, with some being more effective than others. While routine antiemetic prophylaxis is not always necessary, it may be beneficial for high-risk patients. The choice of antiemetic depends on the patient's condition and the type of surgery. Overall, understanding the causes and mechanisms of PONV is essential for effective prevention and treatment.