期刊
EUROPEAN JOURNAL OF PHARMACOLOGY
卷 722, 期 -, 页码 55-66出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.ejphar.2013.10.037
关键词
Nausea; Vomiting; Emesis; Anesthesia; Surgery; Opioid
资金
- National Institutes of Health (Cancer Center Support Grant) [P30CA047904]
Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also increased by several risk predictors, including a young age, female sex, lack of smoking, and a history of motion sickness. Genetic studies are beginning to shed light on the variability in patient experiences of PONV by assessing polymorphisms of gene targets known to play roles in emesis (serotonin type 3, 5-HT3; opioid; muscarinic; and dopamine type 2, D-2, receptors) and the metabolism of antiemetic drugs (e.g., ondansetron). Significant numbers of clinical trials have produced valuable information on pharmacological targets important for controlling PONV (e.g., 5-HT3 and D-2), leading to the current multi-modal approach to inhibit multiple sites in this complex neural system Despite these significant advances, there is still a lack of fundamental knowledge of the mechanisms that drive the hindbrain central pattern generator (emesis) and forebrain pathways (nausea) that produce PONV, particularly the responses to inhalational anesthesia. This gap in knowledge has limited the development of novel effective therapies of PONV. The current review presents the state of knowledge on the biological mechanisms responsible for PONV, summarizing both preclinical and clinical evidence. Finally, potential ways to advance the research of PONV and more recent developments on the study of postdischarge nausea and vomiting (PDNV) are discussed. (C) 2013 Elsevier B.V. All rights reserved.
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