Original contribution
Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia

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Abstract

Study Objective: To assess the frequency of postoperative nausea and vomiting (PONV) in patients following an awake craniotomy compared to general anesthesia for tumor surgery.

Design: Prospective observational and chart review of all patients having a craniotomy for tumor during one year.

Setting: Postanesthesia care unit (PACU) and intensive care unit (ICU) of a university hospital.

Patients: 187 patients were reviewed. 107 patients who had a craniotomy for supratentorial tumor that was less than six hours in duration were analyzed and compared (50 awake craniotomy vs. 57 general anesthesia).

Interventions: Medical records were reviewed for events after the first four hours until discharge. The occurrence and the time of any nausea, vomiting; the administration of antiemetics and analgesic drugs; and complications were documented.

Measurements: Frequency of nausea, vomiting, administration of antiemetics and analgesia, and outcome between the two groups were compared using Chi-square and Student’s t-test.

Main Results : The frequency of nausea (4% vs. 23%; p = 0.012) and vomiting (0% vs. 11%; p = 0.052) were less in patients having an awake craniotomy compared to general anesthesia, but only during the first four hours. The administration of postoperative analgesia was not different between the two groups and did not influence the frequency of PONV.

Conclusion: The frequency of PONV during the initial recovery phase was less in patients having an awake craniotomy for tumor surgery than in patients having a similar procedure with general anesthesia.

Introduction

Postoperative nausea and/or vomiting (PONV) are well known postoperative complications following anesthesia and surgery.1, 2, 3 Many factors may contribute to PONV such as age, gender, duration of procedure, type of anesthetic, and the use of intraoperative and postoperative opioids. Postoperative nausea and vomiting has been documented to occur in a high percentage of patients following a craniotomy.4, 5, 6, 7 It is unpleasant and may result in serious complications in the neurosurgical patient. The majority of craniotomy procedures are performed with general anesthesia; however, an awake craniotomy is an alternative for patients undergoing specific types of procedures such as surgery for epilepsy, or when a lesion is close to areas of eloquent function such as speech, motor, or sensory. Reviews of patients undergoing an awake craniotomy for epilepsy surgery have reported high incidences of nausea and vomiting during the intraoperative period.8, 9, 10 The practice of awake craniotomy for tumor surgery has increased in popularity in many centers, including our hospital.11, 12, 13, 14, 15

The purpose of this study was to assess whether the type of anesthetic and the administration of postoperative analgesia were risk factors for the occurrence of PONV in patients having a craniotomy for tumor resection. We compared patients having an awake craniotomy with patients undergoing general anesthesia for similar tumor surgery.

Section snippets

Materials and methods

With approval of the University Health Network’s institutional review board, all patients undergoing a craniotomy for a tumor during a 12-month period were prospectively followed. The patients were followed in the postanesthetic care unit (PACU) or in the intensive care unit (ICU) by an investigator who was not involved in the anesthetic care of the patient. The patients were placed in the PACU or ICU according to hospital policy. Patients who had an awake craniotomy went to the PACU for 4

Results

In total, 187 patients had a craniotomy for tumor resection. The overall incidence of PONV in these patients was 29%. The location of the tumor was supratentorial in 145 patients and infratentorial in 42 patients. There was a greater incidence of PONV after infratentorial surgery (57%) compared with supratentorial surgery (21%; p = 0.001). All infratentorial procedures were performed with general anesthesia. The duration of the procedure for all patients given general anesthesia (486 ± 213 min)

Discussion

There has been an increase in the awake craniotomy procedure for tumor surgery.11, 12, 13, 14, 15 It has been the clinical impression of our staff that patients who undergo awake craniotomy have less PONV and need fewer analgesic drugs for pain control than patients who have a general anesthetic. Thus, this present study was undertaken to determine the frequency of PONV and to assess the risk factors that may contribute to PONV following a craniotomy for tumor surgery. To do so, we compared

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Cited by (0)

∗

Associate Professor, University of Toronto

†

Neuroanesthesia Fellow, Toronto Western Hospital

1

Present address for Dr. Tong Khee Tan: Singapore General Hospital, Outram Road, Singapore 169608

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