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Nausea and vomiting after laparoscopic surgery are not associated with an increased peripheral release of serotonin

[Les nausées et vomissements suite à une chirurgie laparoscopique ne sont pas associés à une sécrétion périphérique accrue de sérotonine]

From the Department of Anesthesiology, Hôpital de l'Enfant-Jésus du Centre hospitalier affilié universitaire de Québec (CHA), Laval University, Québec, Québec, Canada.

Address correspondence to: Dr. Pierre C. Nicole, Département d'anesthésie-réanimation, Hôpital de l'Enfant-Jésus du Centre hospitalier affilié universitaire de Québec (CHA), 1401, 18^ième rue, Québec, Québec. G1J 1Z4, Canada. Phone: 418-649-0252; Fax: 418-649-5918; E-mail: piernicol{at}sympatico.ca

Purpose: To determine whether patients suffering postoperative nausea and vomiting (PONV) present a different serotonin release pattern from those who do not present this complication.

Methods: Forty-eight consecutive women undergoing outpatient laparoscopic tubal ligation were enrolled in this prospective, cumulative case-control study. The study compared serotonin activity in 15 patients totally free of emetic symptoms (asymptomatic group) and, among patients with PONV (n = 33), those 15 who presented the most severe symptoms (PONV group). Patients were anesthetized with a regimen including sufentanil (0.1–0.3 µg•kg^-1) plus thiopental (3–5 mg·kg^-1) for induction and isoflurane (0.6–1%) in nitrous oxide (60%) for maintenance. Peripheral serotonin activity was assessed by measurement with high-performance liquid chromatography of serotonin's principal urinary metabolite: 5-hydroxyindoacetic acid (5-HIAA) corrected for urinary creatinine.

Results: The preoperative and postoperative urinary 5-HIAA:creatinine ratios were 6.9 ng•µg^-1 (confidence interval; CI 95%, 2.7–11.0) and 5.9 ng•µg^-1 (CI 95%, 2.4–9.4) respectively in the asymptomatic group (P = 0.69), and were 5.1 ng•µg^-1 (CI 95%, 2.5–7.7) and 5.6 ng•µg^-1 (CI 95%, 3.4–7.7) respectively in the PONV group (P = 0.75). There was also no difference between groups in the variation of 5-HIAA:creatinine ratios from the preoperative to the postoperative period (P = 0.21).

Conclusion: PONV after laparoscopic tubal ligation are not associated with an increased urinary excretion of serotonin metabolites. Patients with severe PONV present a peripheral serotonin release comparable to asymptomatic patients.