The background to this topic is the observation of a number of complicated cases of PONV where commonly available antiemetics are ineffective. This is a scenario all too familiar to anesthesia practitioner everywhere. These patients spend hours of wretching and vomiting in the Post-Anesthesia Care Unit (PACU) and sometimes require hospital admission. The repetitive wretching and vomiting has the potential of being harmful to the surgical outcome, e.g. in ophthalmic surgery where bearing down can cause hemorrhages or an undesirable increase in intraocular pressure (IOP). Wound dehiscence and aspiration are potentially serious consequences. Admission to a hospital bed does not improve the condition per se (the antiemetics are just as ineffective as in the PACU) it is most likely the time elapsed from initial event to hospital discharge that plays a role in the resolution of the symptoms. During this time they are often are “parked” in the emergency department for one night before returning home with an experience they would rather forget. Unfortunately, the very same patients have a high chance of experiencing the same event again when exposed to anesthesia and surgery.
In this series of eight cases a distinct relationship to migraine (either as an active disease or heretofore unrecognized or self-medicated) was elicited and treatment with triptans led to immediate resolution of the PONV symptoms. None of the patients described required hospital admission even though their initial presentation would have suggested otherwise.
In conclusion, recommendations are presented to identify PONV patients that may have a background in migraine and would therefore benefit for treatment with triptans.