type: misc

label: url

en: 術後嘔気・嘔吐の最前線

ja: 術後嘔気・嘔吐の最前線

en: Journal of Clinical Anesthesia (Japan)

ja: 臨床麻酔


en: Post-operative nausea and vomiting: the effect of Neurokinin-1 receptor antagonism

ja: 第5回若手奨励賞受賞論文 術後の嘔気・嘔吐--選択的ニューロキニン1受容体拮抗薬が及ぼす影響

en: Post-operative nausea and vomiting(PONV)remains the most frequently reported patientscomplaint after anesthesia, and for patients, it is of greater concern than postoperative pain. PONVhas four main risk factors including : female gender, history of PONV or motion sickness, nonsmoking,and the use of postoperative opioids. Primary control of nausea and vomiting arises from the centralpattern generator for vomiting located in the medulla oblongara.Traditionally, the most common anti-emetics used to treat PONV include serotonin 5-hydroxytryptamine type3antagonists such as ondansetron, corticosteroids, like dexamethasone,or droperidol, which is a neuroleptic. However, these anti-emetics are not completely reliable andonly reduce the incidence of PONV by∼26%. Adding additional anti-emetics could further lowerthe incidence of PONV.PONV can result in several post-surgical complications. Neurokinin-1(NK-1)receptors are foundin gastrointenstinal vagal afferents and within the central nervous system vomiting reflex pathways.NK-1receptors are activated by Substance P, which is a regulatory peptide and preferred endogenousligand.We investigated whether NK-1antagonism can effectively diminish PONV in patients undergoinglaparoscopic gynecological surgery. Forty two patients were randomized into two groups : NK-1group which received an oral NK-1antagonist, aprepitant at80mg, and a control that did not receiveany anti-emetic. PONV incidence at2hours was present in both control and NK-1groups and was81% and52%, respectively. At24hours PONV was present in the control group, but was absentin the NK1group(27% and0%，respectively).PONV is associated with dissatisfaction after anesthesia and surgery, can result in several postsurgicalcomplications. NK-1receptor antagonism effectively lowered PONV, and expedited recoveryin patients undergoing laparoscopic gynecological surgery.

en: Shikoku Acta Medica

ja: 四国医学雑誌