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Osamu KUDOH, Masakazu HAYASHIDA582Objective: Previously, we reported that antiemetics (droperidol and/or dexamethasone) could significantly reduce the incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery (LGS). We retrospectively investigated anesthesia practice during the era earlier than the above-mentioned report to identify factors affecting PONV.Methods: We investigated 1,221 patients who underwent LGS at Juntendo University Hospital between 2007 and 2009. Effects of nine covariates likely to affect PONV on the actual incidence of PONV were examined with the multivariate logistic regression analysis.Results: The actual incidence of PONV developing until nine hours after the transfer to the ward was 47.3% (577/1,221) in the total cohort. The multivariate logistic regression analysis revealed that longer duration of anesthesia (in hours) was associated with the increased incidence of PONV (odds ratio [OR], 1.170; 95% confidence interval [CI], 1.000-1.360; p = 0.0467), the use of the reversal agent neostigmine co-administrated with atropine was associated with the lower incidence of PONV (OR, 0.746; 95% CI, 0.585-0.950; p = 0.0177), and no use of PCA and the use of fentanyl PCA without droperidol were associated with the higher incidence of PONV, compared with the use of fentanyl PCA with droperidol (OR, 1.810; 95% CI, 1.250-2.640; p = 0.0019; and OR, 2.500; 95% CI, 1.880-3.310; p < 0.0001; respectively).Conclusions: Longer duration of anesthesia was associated with the increased incidence of PONV. Addition of droperidol to the PCA infusate and the use of reversal agent neostigmine co-administrated with atropine were associated with the reduced incidence of PONV.Key words: atropine, droperidol, laparoscopic gynecological surgery, neostigmine, postoperative nausea and vomitingJuntendo Medical Journal2022. 68(6), 582-589Original ArticlesHistorical Changes in Anesthesia Practice for Laparoscopic Gynecological Surgery at Juntendo University Hospital – A Retrospective Observational Study Focusing on Factors Affecting the Incidence of Postoperative Nausea and VomitingIntroductionPostoperative nausea and vomiting (PONV) remain among the most common and annoying complications after general anesthesia1). Especially, the incidence of PONV is extremely high after lapa-roscopic gynecological surgery (LGS) for benign diseases, affecting as many as 80% of patients2). Such a high incidence has been attributed to multiple risk factors for PONV related to patients under-Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, JapanCorresponding author: Osamu Kudoh (ORCID: 0000-0002-2390-3662)Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, JapanTEL: +81-3-3812-4746　FAX: +81-3-5689-3820　E-mail: kudora@juntendo.ac.jp〔Received　Mar. 29, 2022〕〔Accepted　Jul. 28, 2022〕J-STAGE Advance published date: Oct. 15, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ22-0013-OAgoing LGS for benign diseases, including female gender, types of surgery (laparoscopic, gynecolog-ical), nonsmoking status, younger age, and postop-erative use of opioids1). Although LGS is catego-rized as minimal invasive surgery due to small skin incisions, postoperative pain is not minimal after LGS due to the development of inflammatory visceral pain, and therefore, opioid analgesics, including those using intravenous patient-controlled anal-gesia (PCA), are often required for adequate pain