Postoperative nausea and vomiting after neurosurgey - (infratentorial and supratentorial surgery)

Objective. - To perform a synthesis regarding postoperative nausea and vomiting (PONV) after neurosurgery. Data extraction. - A Medline search was performed to identify publications about frequency, risk factors, prevention and treatment of PONY in adults and children, after neurosurgery. Data synthesis. - After neurosurgery, the estimated frequency of nausea is around 50% and around 39% for vomiting. After neurosurgery; PONV risk factors are female sex and infratentorial surgery. Children older than two years are at higher risk for PONY. To reduce baseline risk factors, it is recommended to use propofol for induction and maintenance of anaesthesia, to avoid nitrous oxide and to use hydration (20 ml/kg of crystalloids before induction). For PONV prophylaxis, ondansetron and droperidol may be given, using one drug for a moderate risk patient and both drugs for a high-risk patient. Droperidol should not be used in children as a first choice therapy because of an increased risk of extrapyramidal symptoms. Dexamethasone has not been evaluated after neurosurgery. Metoclopramide has no clinically relevant effect for PONY Especially in neurosurgery, after occurrence of PONY it is recommended to rule out a possible triggering factor that should need specific treatment. A global management of PONV is proposed, based on the administration of the same drugs given at half the doses used for prophylaxis. (C) 2004 Elsevier SAS. Tous droits reserves.