The Impact of Aprepitant on Post-Operative Nausea and Vomiting in Endoscopic Skull Base Surgery.

Objective: Post-operative nausea and vomiting (PONV) is common following endoscopic skull base surgery despite multimodal prophylaxis and carries a risk of post-operative bleeding and cerebrospinal fluid (CSF) leakage. This study aims to investigate if pre-operative administration of the neurokinin-1 (NK-1) antagonist, aprepitant, reduces PONV in patients undergoing endoscopic skull base surgery. Methods: A retrospective review of 58 patients undergoing endoscopic skull base surgery was performed. Demographic variables and clinical variables such as anesthesia type, procedural time, intraoperative CSF leak, and co-administration of other antiemetics were collected. Primary outcome was PONV events, defined as the documentation of nausea and/or vomiting in the medical record or use of rescue antiemetic therapy. Post-operative bleeding and CSF leaks were recorded. Univariate and multivariate analyses were conducted in R with the following covariates: co-administered antiemetics, TIVA use, smoking status, ASA score, procedural duration, and intraoperative CSF leak. Results: Of patients who received aprepitant, 42.9% developed PONV compared to 43.2% in the non-aprepitant group. On univariate analysis, there was no difference in PONV (OR 0.98, Conclusion: PONV occurs in nearly half of patients undergoing endonasal skull base surgery. Pre-operative administration of aprepitant was not associated with reduced risk of developing PONV. Level of Evidence: 3.