Mechanisms Underlying Postoperative Nausea and Vomiting and Neurotransmitter Receptor Antagonist-Based Pharmacotherapy
Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications following surgery, and understanding the mechanism(s) underlying PONV is essential to providing optimal prophylaxis and/or treatment of PONV. The knowledge base of PONV physiology has significantly expanded over the past decade.
This article reviews the risk factors for the development of PONV and the mechanisms of action of pharmacological agents (including antagonists of serotonin 5-HT3, dopaminergic D2, histamine H1, muscarinic cholinergic, opioid and neurokinin NK1 receptors) for the management (i.e. prophylaxis and treatment) of PONV. NK1 receptor antagonists, with their unique mechanism of action, are a particularly promising area of research as they appear to be efficacious in preventing PONV during both the early and the late postoperative periods. A successful PONV management strategy includes: (i) identifying patients at risk; (ii) keeping the baseline risk low; and (iii) using a combination of antiemetics acting on different receptors in moderate- to high-risk patients.
KeywordsOndansetron Granisetron Droperidol Aprepitant Motion Sickness
The preparation of this review was supported in part by the Department of Anesthesiology, Duke University Medical Center, and Roche, Inc. Dr Gan has received honoraria from Merck, Roche, Pfizer, Organon, GlaxoSmithKline, Baxter, MGI Pharma and Edwards Life Science. Grants for research support have been received from Pfizer, GlaxoSmithKline, Baxter, Merck, MGI Pharma and Roche.
The author appreciates the assistance of Nelson Erlick, DPM, MS, for his editorial assistance.
- 8.Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth nalg 1999; 88(5): 1085–91Google Scholar
- 21.Miller AD. Central mechanisms of vomiting. Dig Dis Sci 1999; 44(8 Suppl.): 39–43SGoogle Scholar
- 44.Philip BK, McLeskey CH, Chelly JE, et al. Pooled analysis of three large clinical trials to determine the optimal dose of dolasetron mesylate needed to prevent postoperative nausea and vomiting. The Dolasetron Prophylaxis Study Group. J Clin Anesth 2000; 12(1): 1–8Google Scholar
- 57.Notification of the Health Products and Food Branch (HPFB) from Health Canada, June 30, 2006 [online]. Available from URL: http://www.hc-sc.gc.ca/dhp-mps/medeff/advisoriesavis/prof/2006/anzemet_nth-aah_e.html.2007 [Accessed 2007 Jan 3]
- 59.Maxwell LG, Kaufmann SC, Bitzer S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. Anesth Analg 2005; 100(4): 953–8PubMedCrossRefGoogle Scholar