Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors

Latz, Björn; Mordhorst, Christine; Kerz, Thomas; Schmidt, Annette; Schneider, Astrid; Wisser, G.; Werner, Christian; Engelhard, Kristin

doi:10.3171/2010.9.jns10151

Cited by 86 publications

(61 citation statements)

References 28 publications

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“…21 Although PONV symptoms generally occur and resolve in the early post-operative period, cardiac surgery patients reportedly experience persistent GI symptoms for 4e6 weeks post-surgery. 7 Therefore, PONV has implications not only for immediate perioperative outcomes, but also for post-discharge quality of life, cardiac rehabilitation attendance, and return to work. Finally, side effects associated with anti-emetic medications, such as delirium, 22 as well as complications of PONV may result in extended lengths of stay, which in turn directly affect costs to the health care system.…”

Section: Introductionmentioning

confidence: 99%

Post-operative nausea and vomiting in the cardiac surgery population: Who is at risk?

et al. 2014

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Section: Introductionmentioning

confidence: 99%

Post-operative nausea and vomiting in the cardiac surgery population: Who is at risk?

et al. 2014

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“…The preoperative median of GCS was 15 (range, 11-15) in patients of elective group and 14 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15] in patients of non-elective group (p<0.001). The median preoperative period was 5 days (range, 1-62 days) in elective surgeries and 2 days (range, 1-12 days) in the non-elective group (p<0.001).…”

Section: Resultsmentioning

confidence: 93%

“…(15) Interestingly, it has been demonstrated that female sex and the absence of steroids intra-operatively are associated with an increased risk of nausea and vomiting. (15) In patients who underwent emergency skull surgery there were more cases of hypotension, arrhythmia, and cardiac arrest, and greater use of vasoactive drugs in comparison with elective surgery patients. One study that followed patients who underwent electives and emergencies neurosurgeries identified only 0.6% of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…(7,8) In non-elective surgeries, intracranial hypertension, (9) motor deficits, (10) recurrent subdural hematoma, (10,11) intraparenchymal hemorrhage, (12) vasospasms, (13) and seizures (10,14) are also reported. Systemic complications in the postoperative period of elective neurosurgeries include nausea and vomiting, (15) hypotension, respiratory distress, (1) and surgical site infection. (16) For non-elective surgeries, pain (17) and nosocomial infections are also observed.…”

Section: Introductionmentioning

confidence: 99%

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Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

Siqueira

Diccini

2017

Acta paul. enferm.

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Objective: To evaluate the incidence of postoperative complications and mortality among patients submitted to elective or non-elective neurosurgery. Methods: Prospective cohort study in adult patients, followed from preoperative period until hospital discharge or death. Results: One hundred and twenty seven patients were included in elective surgery group and 75 patients in non-elective surgery group. The elective group had more vomiting (p=0.010) and pain (p<0.001) and the non-elective group presented more intracranial hypertension (p=0.001), anisocoria (p=0.002), cerebral vasospasm (p=0.043), light-unresponsive pupil (p=0.006) and reoperation (p=0.046). The mortality rate was 5.5% in the elective surgery group and 26.7% in the non-elective surgery group (p<0.001). Conclusion: Elective procedures in neurosurgery are related to higher frequencies of systemic complications while non-elective surgeries had significantly higher rates of neurological complications and mortality. ResumoObjetivo: Avaliar a incidência de complicações pós-operatorias e mortalidade entre pacientes submetidos a neurocirurcia eletiva e não eletiva. Metodos: Estudo de coorte prospectivo com pacientes adultos, acompanhados desde o período pré-operatório até a alta hospitalar ou óbito. Resultados: Foram incluídos 127 pacientes no grupo cirúrgico eletivo e 75 pacientes no grupo cirúrgico não eletivo. O grupo eletivo teve mais vômitos (p=0,010) e dor (p<0,001) e o grupo não eletivo apresentou mais hipertensão intracraniana (p=0,001), anisocoria (p=0,002), vasoespasmo cerebral (p=0,043), pupilas não fotorreagentes (p=0,006) e reoperação (p=0,046). A taxa de mortalidade foi de 5,5% no grupo de cirurgia eletiva e 26,7% no grupo de cirurgia não eletiva (p<0,001). Conclusão: Os procedimentos eletivos em neurocirurgia estão relacionados a maior frequência de complicações sistêmicas, enquanto as cirurgias não eletivas tiveram taxas significativamente mais altas de complicações neurológicas e mortalidade.

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“…As part of its pharmacodynamic properties, it has an adequate absorption in the gastrointestinal tract and excellent blood–brain barrier penetration. Scopolamine has also been reported to be effective in the prevention of PONV (1, 2, 5, 10, 15, 17, 19–22). The literature showed that IV or intramuscular scopolamine has a short half-life in plasma and may lead to dose-dependent side effects such as excessive drowsiness, agitation, hallucinations, dizziness, dry mouth, and lethargy.…”

Section: Introductionmentioning

confidence: 99%

Triple Therapy with Scopolamine, Ondansetron, and Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Moderate to High-Risk Patients Undergoing Craniotomy Under General Anesthesia: A Pilot Study

et al. 2015

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IntroductionPostoperative nausea and vomiting (PONV) is one of the most common complaints from patients and clinicians after a surgical procedure. According to the current Society of Ambulatory Anesthesia Consensus Guidelines, the general incidence of vomiting and nausea is around 30 and 50%, respectively; and up to 80% in high-risk patients. In previous studies, the reported incidence of PONV at 24 h after craniotomy was 43–70%. The transdermal scopolamine (TDS) delivery system contains a 1.5-mg drug reservoir, which is designed to deliver a continuous slow release of scopolamine through intact skin during the first 72 h of patch application. Therefore, we designed this single arm, non-randomized, pilot study to assess the efficacy and safety of triple therapy with scopolamine, ondansetron, and dexamethasone to prevent PONV.Materials and methodsIn the preoperative area, subjects received an active TDS 1.5 mg that was applied to a hairless patch of skin in the mastoid area approximately 2 h prior to the operation. Immediately after anesthesia induction, all patients received a single 4 mg dose of ondansetron IV and a single 10 mg dose of dexamethasone IV. Patients who experienced nausea and/or vomiting received ondansetron 4 mg IV as the initial rescue medication. Postoperative nausea and vomiting assessments were performed for up to 120 h after surgery.ResultsA total of 36 subjects were analyzed. The overall incidence of PONV during the first 24 h after neurological surgery was 33% (n = 12). The incidence of nausea and emesis during the first 24 h after surgery was recorded as 33% (n = 12) and 16% (n = 6), respectively.ConclusionOur data showed that this triple therapy regimen may be an efficient alternative regimen for PONV prophylaxis in patients undergoing neurological surgery with general anesthesia. Further studies using regimens affecting different receptor pathways should be performed to better prove the efficacy and safety in the prevention or delay of PONV.

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Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors

Cited by 86 publications

References 28 publications

Post-operative nausea and vomiting in the cardiac surgery population: Who is at risk?

Post-operative nausea and vomiting in the cardiac surgery population: Who is at risk?

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

Triple Therapy with Scopolamine, Ondansetron, and Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Moderate to High-Risk Patients Undergoing Craniotomy Under General Anesthesia: A Pilot Study

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