Download PDF
J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 381-386
DOI: 10.1055/s-0039-1685194
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Till Burkhardt   *
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2   Department of Neurosurgery, Friedrich-Ebert-Hospital, Neumünster, Germany
,
Patrick Czorlich   *
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Klaus Christian Mende
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Annika Treitz
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Rainer Kiefmann
3   Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Manfred Westphal
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Nils Ole Schmidt
1   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

27 July 2018

17 October 2018

Publication Date:
10 May 2019 (online)

Also available at
    Permissions and Reprints

Abstract

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.

Keywords

PONV - craniotomy - complications - dexamethasone - CSF leaks

* Till Burkhardt and Patrick Czorlich contributed equally.


 

  • References

  • 1 Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89 (03) 409-423
    CrossrefPubMedSearch in Google Scholar
  • 2 Audibert G, Vial V. Postoperative nausea and vomiting after neurosurgery (infratentorial and supratentorial surgery) [in French]. Ann Fr Anesth Reanim 2004; 23 (04) 422-427
    CrossrefPubMedSearch in Google Scholar
  • 3 Latz B, Mordhorst C, Kerz T. , et al. Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors. J Neurosurg 2011; 114 (02) 491-496
    CrossrefPubMedSearch in Google Scholar
  • 4 Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006; 102 (06) 1884-1898
    CrossrefPubMedSearch in Google Scholar
  • 5 Apfel CC, Heidrich FM, Jukar-Rao S. , et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012; 109 (05) 742-753
    CrossrefPubMedSearch in Google Scholar
  • 6 Apfel CC, Kranke P, Katz MH. , et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002; 88 (05) 659-668
    CrossrefPubMedSearch in Google Scholar
  • 7 Koivuranta M, Läärä E. A survey of postoperative nausea and vomiting. Anaesthesia 1998; 53 (04) 413-414
    PubMedSearch in Google Scholar
  • 8 Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted?. Anesthesiology 1999; 91 (01) 109-118
    CrossrefPubMedSearch in Google Scholar
  • 9 Tramèr MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 1997; 87 (06) 1277-1289
    CrossrefPubMedSearch in Google Scholar
  • 10 Figueredo ED, Canosa LG. Ondansetron in the prophylaxis of postoperative vomiting: a meta-analysis. J Clin Anesth 1998; 10 (03) 211-221
    CrossrefPubMedSearch in Google Scholar
  • 11 Domino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88 (06) 1370-1379
    CrossrefPubMedSearch in Google Scholar
  • 12 Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth 2000; 47 (10) 1008-1018
    CrossrefPubMedSearch in Google Scholar
  • 13 Apfel CC, Korttila K, Abdalla M. , et al; IMPACT Investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350 (24) 2441-2451
    CrossrefPubMedSearch in Google Scholar
  • 14 Scuderi PE, Conlay LA. Postoperative nausea and vomiting and outcome. Int Anesthesiol Clin 2003; 41 (04) 165-174
    CrossrefPubMedSearch in Google Scholar
  • 15 Habib AS, Keifer JC, Borel CO, White WD, Gan TJ. A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy. Anesth Analg 2011; 112 (04) 813-818
    CrossrefPubMedSearch in Google Scholar
  • 16 Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994; 35 (06) 1061-1064 ; discussion 1064–1065
    CrossrefPubMedSearch in Google Scholar
  • 17 Apfel CC, Greim CA, Goepfert C. , et al. Postoperative vomiting. A score for prediction of vomiting risk following inhalation anesthesia [in German]. Anaesthesist 1998; 47 (09) 732-740
    CrossrefPubMedSearch in Google Scholar
  • 18 Fabling JM, Gan TJ, Guy J, Borel CO, el-Moalem HE, Warner DS. Postoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy. J Neurosurg Anesthesiol 1997; 9 (04) 308-312
    CrossrefPubMedSearch in Google Scholar
  • 19 Manninen PH, Tan TK. Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia. J Clin Anesth 2002; 14 (04) 279-283
    CrossrefPubMedSearch in Google Scholar
  • 20 Kurita N, Kawaguchi M, Nakahashi K. , et al. Retrospective analysis of postoperative nausea and vomiting after craniotomy [in Japanese]. Masui 2004; 53 (02) 150-155
    PubMedSearch in Google Scholar
  • 21 Riad W, Marouf H. Combination therapy in the prevention of PONV after strabismus surgery in children: granisetron, ondansetron, midazolam with dexamethasone. Middle East J Anaesthesiol 2009; 20 (03) 431-436
    PubMedSearch in Google Scholar
  • 22 Ormel G, Romundstad L, Lambert-Jensen P, Stubhaug A. Dexamethasone has additive effect when combined with ondansetron and droperidol for treatment of established PONV. Acta Anaesthesiol Scand 2011; 55 (10) 1196-1205
    PubMedSearch in Google Scholar
  • 23 Ryu JH, Chang JE, Kim HR, Hwang JW, Oh AY, Do SH. Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective, randomized, and double-blind study. Int J Surg 2013; 11 (02) 183-187
    CrossrefPubMedSearch in Google Scholar
  • 24 Blume C, Wiederhold H, Geiger M, Clusmann H, Müller CA. Lacking benefit of intraoperative high-dose dexamethasone in instrumented surgery for cervical spondylotic myelopathy. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (02) 116-122
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Merkler AE, Saini V, Kamel H, Stieg PE. Preoperative steroid use and the risk of infectious complications after neurosurgery. Neurohospitalist 2014; 4 (02) 80-85
    PubMedSearch in Google Scholar
  • 26 Mursch K, Buhre W, Behnke-Mursch J, Markakis E. Perioperative cardiovascular stability during brainstem surgery. The use of high-dose methylprednisolone compared to dexamethasone. A retrospective analysis. Acta Anaesthesiol Scand 2000; 44 (04) 378-382
    CrossrefPubMedSearch in Google Scholar
  • 27 Ehrlich HP, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg 1968; 167 (03) 324-328
    CrossrefPubMedSearch in Google Scholar
  • 28 Wicke C, Halliday B, Allen D. , et al. Effects of steroids and retinoids on wound healing. Arch Surg 2000; 135 (11) 1265-1270
    CrossrefPubMedSearch in Google Scholar
  • 29 Corcoran TB, Truyens EB, Ng A, Moseley N, Doyle AC, Margetts L. Anti-emetic dexamethasone and postoperative infection risk: a retrospective cohort study. Anaesth Intensive Care 2010; 38 (04) 654-660
    CrossrefPubMedSearch in Google Scholar
  • 30 Percival VG, Riddell J, Corcoran TB. Single dose dexamethasone for postoperative nausea and vomiting—a matched case-control study of postoperative infection risk. Anaesth Intensive Care 2010; 38 (04) 661-666
    CrossrefPubMedSearch in Google Scholar
  • 31 Bolac CS, Wallace AH, Broadwater G, Havrilesky LJ, Habib AS. The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer. Anesth Analg 2013; 116 (05) 1041-1047
    CrossrefPubMedSearch in Google Scholar
  • 32 Collison PJ, Mettler B. Factors associated with post-tonsillectomy hemorrhage. Ear Nose Throat J 2000; 79 (08) 640-642 , 644, 646 passim
    CrossrefPubMedSearch in Google Scholar
  • 33 Czarnetzki C, Elia N, Lysakowski C. , et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008; 300 (22) 2621-2630
    CrossrefPubMedSearch in Google Scholar
  • 34 van Giezen JJ, Brakkee JG, Dreteler GH, Bouma BN, Jansen JW. Dexamethasone affects platelet aggregation and fibrinolytic activity in rats at different doses which is reflected by their effect on arterial thrombosis. Blood Coagul Fibrinolysis 1994; 5 (02) 249-255
    CrossrefPubMedSearch in Google Scholar
  • 35 Thong KL, Mant MJ, Grace MG. Lack of effect of prednisone administration on bleeding time and platelet function of normal subjects. Br J Haematol 1978; 38 (03) 373-380
    CrossrefPubMedSearch in Google Scholar
  • 36 Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med 2005; 353 (16) 1711-1723
    CrossrefPubMedSearch in Google Scholar