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Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis.

Publication ,  Journal Article
Ouyang, MW; McDonagh, DL; Phillips-Bute, B; James, ML; Friedman, AH; Gan, TJ
Published in: Curr Med Res Opin
September 2013

BACKGROUND: The presence of midline shift on neuroradiologic studies in brain tumor patients represents mass effect from the tumor and surrounding edema. We hypothesized that baseline cerebral edema as measured by midline shift would increase postoperative nausea (PON). We studied the incidence of PON in brain tumor patients, with and without midline shift on preoperative magnetic resonance (MRI) or computed tomographic (CT) imaging, undergoing awake craniotomy. METHODS: After IRB approval, we retrospectively extracted data from perioperative records between January 2005 and December 2010. Post-craniotomy nausea and pain scores were collected. Intraoperative anti-emetic, anesthetic, and analgesic regimens were assessed. Both the rescue anti-emetic and cumulative postoperative analgesic requirements were collected up to 12 hours postoperatively. The amount of midline shift on preoperative neuroimaging was gathered from radiology reports. Univariate comparisons between groups (no midline shift vs. midline shift) were made with t-tests for continuous variables, and chi-square tests for categorical variables. A multivariable analysis was performed to identify predictors of postoperative nausea. Limitations of this study include the retrospective design and the inability to gather accurate data regarding vomiting from the medical record. RESULTS: Data from 386 patients were available for analysis. Patients were divided into two groups: no midline shift (n = 283) and midline shift (n = 103). The mean midline shift distance was 5.96 mm (95% CI [5.32, 6.59]). There was no difference in the incidence of nausea or pain scores between the two groups. More malignant brain tumor patients were in the midline shift group, as determined by the postoperative histopathological diagnosis (P < 0.05). Patients in the midline shift group also had longer anesthesia and surgical times (P < 0.05). CONCLUSION: In patients undergoing a standardized anesthetic for awake craniotomy for tumor resection, the presence of preoperative midline shift did not correlate with postoperative nausea.

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Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

September 2013

Volume

29

Issue

9

Start / End Page

1033 / 1038

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Retrospective Studies
  • Preoperative Care
  • Postoperative Period
  • Postoperative Nausea and Vomiting
  • Pain
  • Middle Aged
  • Medical Records
  • Male
 

Citation

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Ouyang, M. W., McDonagh, D. L., Phillips-Bute, B., James, M. L., Friedman, A. H., & Gan, T. J. (2013). Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis. Curr Med Res Opin, 29(9), 1033–1038. https://doi.org/10.1185/03007995.2013.811071
Ouyang, M. W., David L. McDonagh, Barbara Phillips-Bute, Michael L. James, Allan H. Friedman, and Tong J. Gan. “Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis.Curr Med Res Opin 29, no. 9 (September 2013): 1033–38. https://doi.org/10.1185/03007995.2013.811071.
Ouyang MW, McDonagh DL, Phillips-Bute B, James ML, Friedman AH, Gan TJ. Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis. Curr Med Res Opin. 2013 Sep;29(9):1033–8.
Ouyang, M. W., et al. “Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis.Curr Med Res Opin, vol. 29, no. 9, Sept. 2013, pp. 1033–38. Pubmed, doi:10.1185/03007995.2013.811071.
Ouyang MW, McDonagh DL, Phillips-Bute B, James ML, Friedman AH, Gan TJ. Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis. Curr Med Res Opin. 2013 Sep;29(9):1033–1038.

Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

September 2013

Volume

29

Issue

9

Start / End Page

1033 / 1038

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Retrospective Studies
  • Preoperative Care
  • Postoperative Period
  • Postoperative Nausea and Vomiting
  • Pain
  • Middle Aged
  • Medical Records
  • Male