Postoperative nausea and vomiting (PONV) remain one of the most frequent and distressing complications following general anesthesia and surgery, affecting approximately 20–30% of unselected patients and up to 80% of high-risk individuals. Beyond discomfort, PONV may result in aspiration, wound dehiscence, electrolyte imbalance, prolonged post-anesthesia care unit stay, and unanticipated hospital admission. Risk factors include female gender, nonsmoking status, prior history of motion sickness or PONV, use of volatile anesthetics and opioids, and type of surgery. Prevention strategies focus on risk stratification, multimodal prophylaxis, and anesthetic optimization, including the use of non-general modes of anesthesia when appropriate, total intravenous anesthesia with propofol, opioid-sparing techniques, and perioperative antiemetic therapy. Acute treatment requires prompt recognition, exclusion of alternative diagnoses such as acute myocardial infarction or pancreatitis, and rescue therapy with agents from a different mechanistic class than those given for prophylaxis if possible. Common pharmacologic options include serotonin (5-HT3) antagonists, dopamine antagonists, anticholinergics, corticosteroids, NK1 antagonists, and antihistamines, each with specific mechanisms and side-effect profiles. Anesthesiologists must integrate knowledge of risk factors, mechanisms, and therapeutic options into individualized perioperative care pathways. Effective management of PONV improves patient satisfaction, reduces complications, and optimizes resource utilization.