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
