Patient description: A 54-year-old obese woman admitted to the emergency department with abdominal pain that started 4 days ago with nausea and vomiting. The epigastric pain radiates to the right upper quadrant, getting worse after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and 2 NVDs. She has 2 children, and she is menopausal. She does not smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. She is an obese woman with no acute distress. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones, biliary sludge and CBD stones. The smallest stone is 14mm.

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Postoperative Nausea and Vomiting All of the following must be met for the potential subject to be eligible for participation: 1. The subject is a female scheduled to undergo ambulatory breast surgery performed under general anesthesia 2. The subject is expected to undergo general inhalation anesthesia. 3. The subject presents with two of the three following high-risk factors associated with PONV (must be in their medical history in order to be eligible) She is a non-smoker She has documented history of PONV and/or motion sickness She is expected to receive intra-operative and postoperative opioid. 4. The subject's American Society of Anesthesiologist physical status is ASA I-III 5. The subject is between18 to 65 years of age. 6. The subject is expected to be discharged from the hospital/surgical center on the same day as the surgery. 7. The subject has provided written informed consent to participate in the study. If any of the following  are met, the potential subject is NOT eligible for participation: 1. The subject has a history of allergic reaction to, intolerances of or contraindications for any of the study medications or required anesthetic agents. 2. The subject has received or is expected to receive any excluded preoperative drug within 48 hours prior to induction; or is expected to receive any excluded intra-operative or postoperative medications. 3. The subject is pregnant or lactating. (If the potential subject is pre-menopausal, a urine pregnancy test must be performed within 24 hours/1 day of study prior to the planned surgery time and confirmed negative in order for the potential subject to be enrolled). 4. The subject is taking warfarin. 5. The subject has a history of alcohol and/or drug abuse within 1 year of study medication, or has a positive screening or pre-study test for alcohol or drugs of abuse. 6. The subject is expected to require the use of a nasogastric tube postoperatively. 7. The subject has a diagnosed latex allergy. 8. The subject has used oral aprepitant (Emend®) within the last 30 days. 9. The subject has participated in a randomized study or has been exposed to any experimental drug within 30 days prior to enrollment of this study