Abstract
Purpose
To determine whether patients suffering postoperative nausea and vomiting (PONV) present a different serotonin release pattern from those who do not present this complication.
Methods
Forty-eight consecutive women undergoing outpatient laparoscopic tubal ligation were enrolled in this prospective, cumulative case-control study. The study compared serotonin activity in 15 patients totally free of emetic symptoms (asymptomatic group) and, among patients with PONV (n = 33), those 15 who presented the most severe symptoms (PONV group). Patients were anesthetized with a regimen including sufentanil (0.1–0.3 μg·kg−1) plus thiopental (3–5 mg·kg−1) for induction and isoflurane (0.6–1%) in nitrous oxide (60%) for maintenance. Peripheral serotonin activity was assessed by measurement with high-performance liquid chromatography of serotonin’s principal urinary metabolite: 5-hydroxyindoacetic acid (5-HIAA) corrected for urinary creatinine.
Results
The preoperative and postoperative urinary 5-HIAA: creatinine ratios were 6.9 ng·μg−1 (confidence interval; CI 95%, 2.7–11.0) and 5.9 ng·μg−1 (CI 95%, 2.4–9.4) respectively in the asymptomatic group (P = 0.69), and were 5.1 ng·μg−1 (CI 95%, 2.5–7.7) and 5.6 ng·μg−1 (CI 95%, 3.4–7.7) respectively in the PONV group (P = 0.75). There was also no difference between groups in the variation of 5-HIAA: creatinine ratios from the preoperative to the postoperative period (P = 0.21).
Conclusion
PONV after laparoscopic tubal ligation are not associated with an increased urinary excretion of serotonin metabolites. Patients with severe PONV present a peripheral serotonin release comparable to asymptomatic patients.
Résumé
Objectif
Déterminer si les patientes souffrant de nausées et vomissements postopératoires (NVPO) ont un profil de sécrétion de la sérotonine différent de celles qui ne présentent pas cette complication.
Méthode
Quarante-huit femmes qui se sont présentées successivement en chirurgie ambulatoire pour une ligature tubaire par laparoscopie ont participé à cette étude prospective cas-témoins. Le profil de sécrétion de la sérotonine chez 15 patientes qui ne présentaient aucun symptôme émétique (groupe asymptomatique) a été, comparé à celui des 15 patientes ayant présenté les symptômes les plus sévères (groupe NVPO). L’anesthésie a été induite avec du sufentanil (0,1 –0,3 μg·kg−1) et du thiopental (3–5 mg·kg−1) et maintenue avec de l’isofurane (à 0,6 –1 %) dans du protoxyde d’azote (à 60 %). L’activité périphérique de la sérotonine a été évaluée par la mesure du principal métabolite urinaire de la sérotonine au moyen de la Chromatographie liquide haute performance: l’acide 5-hydroxy-indole acétique (5-HIAA) corrigé pour la créatinine urinaire.
Résultats
Les ratios 5-HIAA urinaire préopératoire et postopératoire: créatinine ont été de 6,9 ng·μg−1 (intervalle de confiance IC de 95 %, 2,7–11,0) et de 5,9 ng·μg−1 (IC 95 %, 2,4–9,4) respectivement chez tes patientes asymptomatiques (P = 0, 69), et de 5,1 ng·μg−1 (IC 95 %, 2,5–7,7) et 5,6 ng·μg−1 (IC 95 %, 3,4–7,7) respectivement pour tes patientes du groupe NVPO (P = 0,75). Il n’y a pas eu de différence intergroupe pour la variation des ratios 5-HIAA:créatinine entre les périodes préopératoire et postopératoire (P = 0,21).
Conclusion
Les NVPO suivant la ligature des trompes laparoscopique ne sont pas associés à une sécrétion urinaire accrue des métabolites de la sérotonine. La sécrétion périphérique de sérotonine est comparable pour les patientes qui souffrent de NVPO sévères et les patientes asymptomatiques.
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Nicole, P.C., Trepanier, C.A. & Lessard, M.R. Nausea and vomiting after laparoscopic surgery are not associated with an increased peripheral release of serotonin. Can J Anesth 49, 453–457 (2002). https://doi.org/10.1007/BF03017919
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DOI: https://doi.org/10.1007/BF03017919