Anesthesiologists and anesthesiologists-in-training and other anesthesia professionals, nurse anesthetists and anesthesia assistants.

Upon completion of this activity, participants should be able to:

• Improve patient PONV outcomes by implementing the proposed 5-drug antiemetic prophylaxis scheme, comprised of all-FDA-approved off-patent medications.
  
• Recognize the disadvantages of limited PONV prophylaxis, for which a "law of diminishing returns" seemed to apply in 1990s-contemporaneous landmark studies, representing an earlier era that may now finally be meaningfully advanced for patient-centered benefits. 
• Witness one approach to (i) questioning the objectives and methods of a self-appointed Consensus Guideline Committee, and (ii) effectively identifying and reporting suspected shortcomings that, once corrected, significantly benefit patient care.

Joint Accreditation Statement:

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The University of Pittsburgh School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Each physician should only claim credit commensurate with the extent of their participation in the activity. 

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Suggested Additional Reading

1. BA Williams, JM Holder-Murray...JW Ibinson, JS DeRenzo, C Dalessandro, ML Kentor, A Herlich, et al. Aim for zero: Prevention of postoperative nausea and vomiting using an off-patent five-drug multimodal approach. Br J Anaesth 2023;131(1): e1-e4
   
2. BA Williams, ML Kentor, JJ Irrgang, MT Bottegal and J.P. Williams. Nausea, vomiting, sleep, and restfulness upon discharge home after outpatient anterior cruciate ligament reconstruction with regional anesthesia and multimodal analgesia/antiemesis. Reg Anesth Pain Med 2007;32(3):193-202.
3. Williams BA, Holder-Murray JM, Esper SA, Subramaniam K, Skledar SJ, Kentor ML, Orebaugh SL, Mangione MP, Ibinson JW, Waters JH, Williams JP, Chelly JE. Oral Perphenazine 8 mg: A Low-Cost, Efficacious Antiemetic Option. Anesth Analg 2021;132(2):e29-e31.
4. Williams BA, Kentor ML, Skledar SJ, Orebaugh SL, Vallejo MC. Routine multimodal antiemesis including low-dose perphenazine in an ambulatory surgery unit of a university hospital: a 10-year history. Supplement to: Eliminating postoperative nausea and vomiting in outpatient surgery with multimodal strategies including low doses of nonsedating, off-patent antiemetics: Is "zero tolerance" achievable? ScientificWorldJournal 2007; 7:959-986 (manuscript and supplement).