Postoperative Nausea and Vomiting Following Craniotomy: Risk Factors and Complications in Context of Perioperative High-dose Dexamethasone Application

Introduction Postoperative nausea and vomiting (PONV) is common in patients after craniotomy and may lead to severe postoperative complications. The aim of this study was to identify risk factors and postoperative complications associated with PONV in the context of perioperative high-dose dexamethasone administration. Patients and Methods In this prospective single-center study, all patients planned for elective craniotomy for supra- and infratentorial lesions were eligible to be included. Any PONV in a 24-hour period after craniotomy was recorded and analyzed with regard to time to postoperative complications and the administration of perioperatively administered high-dose dexamethasone. Results The overall PONV rate of 421 patients during a 9-month period was 18.1% (76 patients). Multivariate analysis revealed a significant association of PONV with female sex, infratentorial localization, age, and history of PONV. There was no association between PONV and postoperative complications such as intracranial hemorrhage, cerebrospinal fluid (CSF) leaks, or pneumonia. Perioperative administration of high-dose dexamethasone for prophylactic prevention of edema was the only significant risk factor for postoperative complications (odds ratio [OR]: 3.34; confidence interval [CI], 1.39–8.05; p < 0.01) with a highly significant association with the occurrence of CSF leaks (OR: 6.85; CI, 1.62–29.05; p < 0.01). Conclusion The low PONV rate of 18.1% in this study may be the result of the frequent perioperative administration of high-dose dexamethasone for the prevention of edema. Our data indicate that perioperative high-dose dexamethasone is significantly associated with CSF leaks and can therefore not be recommended on a regular basis.

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Consideration of Migraines Among Risk Factors for Postoperative Nausea and Vomiting

Journal of Clinical Medicine ◽

10.3390/jcm9103154 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3154

Author(s):

Jong-Ho Kim ◽

Man-sup Lim ◽

Sang-Hwa Lee ◽

Young-Suk Kwon ◽

Jae Jun Lee ◽

...

Keyword(s):

Risk Factors ◽

Clinical Data ◽

Postoperative Nausea ◽

Medical Center ◽

Significant Risk ◽

Postoperative Nausea And Vomiting ◽

Significant Risk Factor ◽

Nausea And Vomiting ◽

History Of ◽

The Impact

The impact of migraine on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. Thus, we investigated the impact of migraine, among other risk factors, on PONV in a large retrospective study. We analyzed 10 years of clinical data from the Smart Clinical Data Warehouse of Hallym University Medical Center. PONV was defined as nausea or vomiting within the first 24 h after surgery. Patients diagnosed by a neurologist and with a history of triptan use before surgery were enrolled into the migraine group. We enrolled 208,029 patients aged > 18 years who underwent general anesthesia (GA), among whom 19,786 developed PONV within 24 h after GA and 1982 had migraine. Before propensity score matching, the unadjusted and fully adjusted odds ratios (ORs) for PONV in subjects with versus without migraine were 1.52 (95% confidence interval (CI), 1.34–1.72; p < 0.001) and 1.37 (95% CI, 1.21–1.56; p < 0.001), respectively. The OR for PONV in patients with migraine was also high (OR, 1.37; 95% CI, 1.13–1.66; p = 0.001) after matching. Our findings suggest that migraine is a significant risk factor for PONV.

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Singapore General Hospital Experience on Ethnicity and the Incidence of Postoperative Nausea and Vomiting after Elective Orthopaedic Surgeries

Journal of Anesthesiology ◽

10.1155/2015/952302 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Xin Yu Adeline Leong ◽

Xian Wen Charlene Kwa ◽

Shu Hui Elizabeth Ng ◽

Liang Khai Darren Koh

Keyword(s):

Risk Factors ◽

Nitrous Oxide ◽

Postoperative Nausea ◽

Significant Risk ◽

Postoperative Nausea And Vomiting ◽

Significant Risk Factor ◽

Nausea And Vomiting ◽

Singapore General Hospital ◽

Significant Difference ◽

Risk Patients

Introduction. We explored how ethnicity affects the risk of postoperative nausea and vomiting (PONV) and established the correlation of suggested risk factors of PONV in the multiethnic population of Singapore. Methods. 785 patients who underwent orthopaedic surgery were recruited. These comprised 619 Chinese (78.9%), 76 Malay (9.7%), 68 Indian (8.7%), and 22 other (2.8%) cases. The presence of possible risk factors of PONV and nausea and/or vomiting within 24 h after surgery was studied. Univariate and multivariate logistic regression analyses were performed. Results. The incidence of PONV was 33.2% (261 patients). There was no statistically significant difference of PONV incidence between Chinese, Malay, and Indian cases (34.6% versus 34.2% versus 29.4%, p=0.695). Indian females younger than 50 years were found to have a higher incidence of vomiting (p=0.02). The significant risk factors for this population include females, use of nitrous oxide, and a history of PONV. Conclusion. In the groups studied, ethnicity is not a significant risk factor for PONV except for young Indian females who have a higher risk of postoperative vomiting. We suggest the selective usage of antiemetic for young Indian females as prophylaxis and avoiding nitrous oxide use in high-risk patients.

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Faculty Opinions recommendation of Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1052783.504699 ◽

2006 ◽

Author(s):

Armin Schubert

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Microvascular Decompression ◽

Postoperative Nausea ◽

Cranial Nerves ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting

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Prediction of Postoperative Nausea and Vomiting Using Clinical Risk Factors

Problems of the Gastrointestinal Tract in Anesthesia, the Perioperative Period, and Intensive Care ◽

10.1007/978-3-642-60200-9_32 ◽

1999 ◽

pp. 289-301

Author(s):

C. C. Apfel ◽

N. Roewer

Keyword(s):

Risk Factors ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Clinical Risk Factors ◽

Clinical Risk

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Prevention of Postoperative Nausea and Vomiting

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0028 ◽

2018 ◽

pp. 147-152

Keyword(s):

Risk Factors ◽

Nitrous Oxide ◽

Relative Risk ◽

Adverse Events ◽

Postoperative Nausea ◽

Volatile Anesthetic ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Baseline Risk ◽

Maximum Reduction

This case focuses on the prevention of postoperative nausea and vomiting (PONV) by asking the question: What is the efficacy of six well-established prophylactic antiemetic strategies individually and in combination for the prevention of postoperative nausea and vomiting? Each of the three antiemetics in this study (ondansetron, dexamethasone, and droperidol) reduced the risk for PONV by approximately 26%; substituting propofol for volatile anesthetic reduced the risk by 19%; and substituting nitrogen (air) for nitrous oxide reduced the risk by 12%. A maximum reduction of 70% in the relative risk for PONV can be expected when total intravenous anesthesia is used with three antiemetics. The appropriate approach to the management of PONV depends on the patient’s baseline risk factors as well as the likelihood of adverse events and costs from the antiemetic medications.

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