A Prospective Survey And Polymorphisms Of The HTR3Gene In Postoperative Nausea And Vomiting

Part1Incidence and risk factors of Postoperative Nausea and Vomiting after Gynecological surgeryObjective:Postoperative nausea and vomiting (PONV) is the most common postoperative complication after surgery and general anesthesia. PONV occurs primarily within the first24hours and can lead to significant morbidity, delayed hospital discharge, increased hospital costs and perhaps most importantly, poor patient satisfaction. We sought, in this study, to determine the prevalence of PONV and to identify risk factors in patients who underwent gynecological laparoscopic surgery.Methods:We conducted a prospective observational study design of535consecutive patients over18years of age, who underwent laparoscopic surgery (uni-or bilateral ovarian resection, ovarian cyst resection, hysterectomy and fibroidectomy) at Sir Run Run Shaw hospital, Zhejiang University School of Medicine, between December2009and December2011. Patient-, anesthesia-and surgery-related factors that were considered to have a possible effect on the prevalence of PONV events were evaluated during first4h and5-24h after surgery.Results:A total of492patients met the inclusion criteria. Among these patients,28.65%experienced PONV during the first4hours after surgery, and49.17%suffered form PONV during5-24h after surgery. The most important predictive factors associated with an increased risk of PONV were nonsmoking status, presence of predisposing factors (prior history of PONV) and the use of postoperative analgesic morphine during first24hours after surgery. The postoperative pain level (PACU) and shivering following surgery will intensify the risk for development of PONV within4h after surgery.Conclusion:We found PONV had a high prevalence among patients undergoing gynecological laparoscopic surgery. The most important predictive factors associated with increased risk for nausea and vomiting were a previous history of PONV, a longer duration of surgery, nonsmoking, use of postoperative analgesic morphine and a history of motion sickness. Further studies are needed to develop effective protocols for preventing this common and unpleasant problem. Part2Polymorphisms of the HTR3B gene are associated with post-surgery emesis in a Chinese Han populationObjective:The serotoninergic receptor5-hydroxytryptamine (serotonin) receptor3(HTR3) is instrumental in the regulation of nausea and emesis (vomiting).This study investigated whether common genomic variations of the A and B subunits of HTR3(HTR3A, HTR3B) are associated with the incidence of postoperative vomiting in a Chinese Han population.Method:Two hundred and thirty-one female Chinese Han patients undergoing gynecological surgery with standardized general anaesthesia were recruited for the study. Clinical symptoms after surgery were recorded and direct DNA sequencing was performed to detect polymorphisms of HTR3A and HTR3B.Results:Ten single nucleotide polymorphisms (SNPs) in HTR3A and HTR3B were found. One of these (rs3758987in HTR3B) was statistically associated with vomiting, after adjusting for body weight, body mass index and duration of general anaesthesia in dominant and additive models (P=0.047and P=0.034). Cox propotional regression analysis resulted in a hazards ratio of1.312(95%CI:1.004-2.241) for CT and1.502(95%CI:0.611-3.714) for CC genotype, with TT being the reference.Conclusion:The HTR3B rs3758987SNP might serve as a predictor of postoperative vomiting in Chinese Han patients undergoing gynecological laparoscopic surgery.