Postoperative Nausea and Vomiting (PONV) is one of the most distressing experiences associated with surgery, and many patients find it more troublesome than postoperative pain itself.
It is not only very uncomfortable to the patient in the postoperative period but it also delays the time of starting enteral feeding and normal functions. Especially in day care surgeries were the patents leave the hospital on the same day severe Postoperative Nausea and Vomiting or PONV can result in readmission of the patient to the hospital.
Over the last few years, several studies have laid an emphasis on the efficacy of a balanced antiemetic approach, involving drugs that act at different sites and receptors. Such combinations include the 5HT3 antagonists with cyclizine, droperidol, dexamethasone and others.
A recent meta-analysis on prevention of Postoperative Nausea and Vomiting consensus guidelines recommended a combination of dexamethasone with the 5HT3 receptor antagonists.
More recently, multimodal management strategies, incorporating changes in anaesthetic technique, optimum fluid management and pain relief strategies have produced even better results in management of Postoperative Nausea and Vomiting or PONV. The desirable antiemetic agent in a neurosurgery patient should be effective, provide minimal sedation and should not affect the seizure threshold.
Many institutes are using 5-hydroxy tryptamine antagonist, ondansetron (100 microgram/kg intravenously) at the end of neurosurgical procedure as patients are already receiving dexamethasone/ methyl prednisolone in the perioperative period.