We have observed that patients, after retromastoid
craniectomy (RMC) with
microvascular decompression (MVD) of cranial nerves, frequently experienced
postoperative nausea and vomiting (
PONV). The authors conducted this study to track the incidence of
PONV and to identify potential factors for
PONV after RMC with MVD. Medical records from 185 adults, who underwent elective RMC with MVD, were identified and reviewed from January 2000 to December 2004. Extracted data included patient,
anesthesia, and surgery related variables that were considered to have a possible effect on the patients experiencing
PONV after RMC with MVD. Despite the use of intraoperative prophylactic
ondansetron in 99% of patients, the overall incidence of
PONV (
nausea or
emesis or both) was 60% during the first 24 hours postoperatively. It was higher for the patients after RMC with MVD of cranial nerve V [69%, 82/119, P=0.005, odds ratio (OR)=2.8]. Regression modeling demonstrated that female sex (OR=3.0, P=0.005) and use of
desflurane (OR=2.8, P=0.003) were significant independent predictors of
PONV. Prophylactic transdermal
scopolamine patch administered preoperatively was associated with less
PONV (OR=0.3, P=0.001). We concluded that
PONV occurs frequently in adults recovering from RMC with MVD. The results of this study suggest that it may be necessary to administer a combination of
antiemetics to decrease the incidence of
PONV after RMC.