Management of postoperative nausea and vomiting after neurosurgery

Postoperative nausea and vomiting (PONV) constitutes a major unpleasant symptom after anesthesia and surgery. The current overall incidence of PONV for all surgeries is estimated to be 25–30%, whereas after craniotomies is more than 50%. In the absence of prophylactic antiemetics, in retrospective analysis, the incidence has been as high as 39% for emesis and 67% for nausea, while in prospective studies PONV incidence has been reported from 55 to 70%. The reasons for the high incidence of PONV in neurosurgical patients may relate to surgery being performed in close proximity to emetic centers of the brainstem, or on the structures integral to maintenance of equilibrium.