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Research Snapshot Theater: Neuroscience, Pediatric II

Comparison of Intraoperative Antiemetics for Pediatric Chiari Decompression

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 06

  • Hananh R. Ford, MD, FAAP (she/her/hers)

    Lucile Packard Children's Hospital at Stanford University, California

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • PT

    Prathyusha Teeyagura, MSBI

    Data Analyst
    Stanford University School of Medicine, California

    Disclosure information not submitted.

  • ID

    Isabella Dang, N/A

    Research Assistant
    Stanford University, California

    Disclosure information not submitted.

  • MC

    Michael Chen, MD

    Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
    Stanford University School of Medicine, California

    Disclosure information not submitted.

  • LR

    Lindsey Rasmussen, MD

    Clinical Associate Professor of Pediatrics, Division of Critical Care Medicine
    Stanford University School of Medicine, California

    Disclosure information not submitted.

Introduction: Post-operative nausea and vomiting (PONV) is a known complication of foramen magnum decompression (FMD) for Chiari malformation. Aprepitant, whether used alone or in combination with ondansetron and/or dexamethasone, has been shown to outperform ondansetron for PONV. No studies to date have examined the potential impact of a specific perioperative antiemetic regimen in a specific pediatric surgery. This study aims to address that gap in the literature for pediatric FMD. We hypothesized that patients who received intraoperative fosaprepitant (F) or aprepitant (A) would have decreased PONV and pain without significant difference in length of stay (LOS) compared to other perioperative antiemetic regimens.


Methods: We performed a retrospective chart review of all patients who were admitted for and underwent FMD for Chiari malformation September 2014 through August 2024 at a quaternary pediatric hospital. Patients were excluded for PICU LOS greater than 4 days, undergoing repeat FMD or multiple invasive procedures, inability to extubate in operating room, and discharging deceased. Data analysis included descriptive statistics and univariate analysis.


Results: 178 patients were identified, of whom 80 (44.9%) received intraoperative F/A. Of those, 68.8% were female with a median age was 14 years [11.6-16.2] compared to 53% female and age 7.4 years [4.1-12.1] in those that did not receive F/A. Average PICU LOS was 1.2 days and hospital LOS 3.7 days for the F/A cohort compared to 1.3 days and 4 days (p-values 0.13 and 0.05). 3.8% of the F/A cohort had significant emesis (3 or more bouts) compared to 50% (OR 0.04, 95%CI 0.01-0.13, p-value < 0.01). 72.5% of the F/A cohort had severe (>= 7/10) pain within 24 hours of surgery compared to 75.5% (OR 0.86, 95%CI 0.44-1.68, p-value 0.33).


Conclusions: Patients who received intraoperative F/A compared to those who did not had decreased odds of significant post-operative emesis. We discovered heterogeneity in post-operative pharmacotherapy regimens that may contribute to the lack of effect on pain. The standard addition of F/A to intraoperative care for FMD should be considered especially for patients at higher risk of PONV. Future study of specifically protocolized intraoperative care for FMD and patient outcomes is merited.