Blood-borne factors possibly associated with post-operative nausea and vomiting: an explorative study in women after breast cancer surgery.
BACKGROUND
The pathophysiology behind post-operative nausea and vomiting (PONV) is still not fully understood, especially with respect to gender. According to PONV risk scores, female gender is the strongest predictor for PONV. The risk for PONV after general anaesthesia for breast cancer surgery is 50-80%. The aim of the present explorative study was to identify blood-borne factors that might be associated with the development of PONV in women undergoing breast cancer surgery as a basis for further studies.


METHODS
Fifty patients were enrolled prospectively in the study. A standardized sevoflurane-based anaesthetic was used. Blood samples for the analysis of vasopressin, gastrin, cholecystokinin, epinephrine, norepinephrine, dopamine, serotonin, platelet count and blood glucose were taken at six pre-determined time points peri-operatively, and PONV was assessed during 24 h.


RESULTS
PONV was found in 27 of 47 patients completing the study. Patients with PONV had a larger variability of the platelet count (P = 0.001), a reduced platelet count on the first post-operative day (P = 0.02) and a less pronounced relationship between the platelet count and whole blood serotonin (P = 0.004) compared with non-PONV patients. A lack of a decrease in epinephrine levels in response to the induction of anaesthesia (P = 0.03) and increased levels of vasopressin (P < 0.001), epinephrine (P = 0.005) and blood glucose (P = 0.004) were observed in the early post-operative period in PONV patients.


CONCLUSIONS
Three different platelet-associated factors and an altered epinephrine pattern were found to be associated with the occurrence of PONV after breast cancer surgery.
Oddby-Muhrbeck
E
E
Division of Anaesthesia and Intensive Care, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden. eva.oddby@ds.se
Eksborg
S
S
Helander
A
A
Bjellerup
P
P
Lindahl
S
S
Lönnqvist
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D000932:Antiemetics / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001943:Breast Neoplasms / Q000601:surgery*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D008738:Methyl Ethers; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications; D010976:Platelet Count; D020250:Postoperative Nausea and Vomiting / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies; D012701:Serotonin / Q000097:blood; D000077149:Sevoflurane; D013312:Stress, Physiological / Q000503:physiopathology; D014667:Vasopressins / Q000097:blood
D018685:Anesthetics, Inhalation; D000932:Antiemetics; D001786:Blood Glucose; D006728:Hormones; D008738:Methyl Ethers; D014667:Vasopressins; D012701:Serotonin; D000077149:Sevoflurane; D017294:Ondansetron; D004837:Epinephrine