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PubMed · 9054067

[Postoperative nausea and vomiting].

Abstract

Postoperative nausea and vomiting (PONV) is still a problem and is very discomforting for the patients. As surgery done on out-patient basis becomes more frequent, PONV will represent an important factor in the length of recovery room stay, and is in this way an economic problem. Based on the literature from 1985-1995 factors associated with increased risk, prevention and treatment of PONV are discussed in view of the physiological mechanisms. The conclusion is that PONV is a complex problem. It demands an individual evaluation with a careful preoperative visit including planning of both preanaesthetic and anaesthetic agents. Furthermore, a proper anaesthetic treatment of the per- and postoperative course is of high importance. Patients at high risk of PONV should be identified and given prophylactic antiemetics.

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BibTeXRIS

L B Jensen, K M Jensen, S C Gellett. 1997-01-13. [Postoperative nausea and vomiting].. https://pubmed.ncbi.nlm.nih.gov/9054067/

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Barbiturates were introduced into medical practice in 1934. They are widely used today as general anesthetics. Although in vitro studies revealed that the activity of a variety of ligand-gated channels is modulated by barbiturates, the target(s) mediating the anesthetic actions of barbiturates in vivo are unknown. Studying pentobarbital action in beta3(N265M) mice harboring beta3-containing GABAA receptors insensitive to a variety of general anesthetic agents, we found that the immobilizing action of pentobarbital is mediated fully, and the hypnotic action is mediated in part by this receptor subtype. It was surprising that the respiratory depressant action of pentobarbital is indistinguishable between beta3(N265M) and wild-type mice and thus is mediated by other as-yet-unidentified targets. Whereas the target for the immobilizing and hypnotic actions of pentobarbital seems to be the same as for etomidate and propofol, these latter agents' respiratory depressant actions are mediated by beta3-containing GABAA receptors. Thus, in contrast to etomidate and propofol, pentobarbital can elicit respiratory depression by a beta3-independent pathway. Pentobarbital reduced heart rate and body temperature to a slightly smaller extent in beta3(N265M) mice compared with wild-type mice, indicating that these actions are largely mediated by other targets. Pentobarbital-induced increase of heart rate variability and prolongation of ECG intervals are seen in both beta3(N265M) mice and wild-type mice, suggesting that they are not dependent on beta3-containing GABAA receptors. In summary, we show a clear pharmacological dissociation of the immobilizing/hypnotic and respiratory/cardiovascular actions of pentobarbital.

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