ABSTRACT
Postoperative nausea and vomiting (PONV) in neurosurgical patients can lead to dreaded consequences, such as increase in ICP, intracranial hemorrhage, increased mortality and morbidity, and prolonged hospital stay. The complications associated with PONV include fluid and electrolyte imbalance, airway compromise, venous hypertension, wound dehiscence, and surgical site hematoma. The vomiting center (VC) and chemoreceptor trigger zone (CTZ) are the centers in brain that are involved in PONV. The VC is located in the lateral reticular formation of brain stem and coordinates with the smooth and striated muscles in the genesis of vomiting. The CTZ is situated in the area postrema on the floor of fourth ventricle. In general surgical populations, the risk factors for PONV have been described as patient factors, surgical factors, and anesthetic factors. As the mechanism of PONV involves multiple receptors, multimodal management and combination of drugs should be used for its prophylaxis.
