Background Postoperative nausea and vomiting is one of the most common complications following surgery under anesthesia, and the incidence is up to 30%. Despite the existence of consensus and guidelines on how to manage PONV, the weakest link of the chain from research to practice is the implementation of well proven recommendations. Objective This review summarized the main barrier about implementing the guidelines in clinical practice and provided a more effective approach about how to control PONV. Content The sophisticated predictive algorithems of PONV are the most important hurdles to eliminating PONV .Multicodal prevention may provide a more simple and effective approah to manage PONV. Trend Such an approach would be more acceptable and appliable for clinical anesthesiologists. New agents, such as NK1-antagonists or the new 5-HT3 antagonists, and traditional antiemetics are valuable components in multimodal prevention.