title: Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes?
abstract: Although opioid-induced nausea and vomiting (OINV) is common and debilitating, its mechanism is still unclear. Recently, we suggested that opioids affect semicircular canal function and that this leads to a mismatch between canal input and other sensory information during head motion, which triggers OINV. Here, we assess if visual input is relevant for this mismatch. In a randomized-controlled crossover study 14 healthy men (26.9±3.4 years, mean±SD) were tested twice, once blindfolded and once with eyes open, with at least one-day washout. The opioid remifentanil was administered intravenously (0.15 μg/kg/min) for 60 minutes. After a thirty-minutes resting period, subjects' head and trunk were passively moved. Nausea was rated before remifentanil start (T0), before the movement intervention (T30) and after 60 minutes (T60) of administration. At rest (T0, T30), median nausea ratings were zero whether subjects were blindfolded or not. Movement triggered nausea independently of visual input (nausea rating 1.5/3.0 (median/interquartile range) in the blindfolded, 2.5/6 in the eyes-open condition, χ2(1) = 1.3, p = 0.25). As movement exacerbates OINV independently of visual input, a clash between visual and semicircular canal information is not the relevant trigger for OINV. To prevent OINV, emphasis should be put on head-rest, eye-closure is less important.
authors.affiliation: Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Heuser
authors.affiliation: Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulz
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.
authors.forename: Murat
authors.initials: M
authors.lastname: Sağlam
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ramaioli
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.|Department of Neurology, Klinikum der Universität München, Munich, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Heuberger
authors.affiliation: Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Wagner
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.|Schön Klinik, Bad Aibling, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Jahn
authors.affiliation: Brandenburg University of Technology, Cottbus-Senftenberg, Germany.
authors.forename: Erich
authors.initials: E
authors.lastname: Schneider
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.|Institute for Clinical Neurosciences, Klinikum der Universität München, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.|Department of Neurology, Klinikum der Universität München, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Glasauer
authors.affiliation: German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.|Department of Neurology, Klinikum der Universität München, Munich, Germany.|Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Lehnen
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D018592:Cross-Over Studies; D005123:Eye; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D012146:Rest; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid