The effect of plasma 5-hydroxy indole acetic acid (5-HIAA) concentration and serotonin receptor polymorphism on postoperative nausea and vomiting (PONV)

ABSTRACT

BACKGROUND: Post-operative nausea and vomiting (PONV) is a common problem in the patients undergoing laparoscopic surgery. The release of serotonin during surgical procedure may induce PONV. We investigated if postoperative increase in plasma serotonin metabolite and genotype of serotonin receptor were associated with PONV after gynecologic laparoscopic surgery. METHODS: The patients who experienced nausea after gynecologic laparoscopic surgery (PONV group, n = 20) and who had no or mild nausea (control group, n = 20) were enrolled. Median value of nausea (100 mm visual analogue scale, VAS) was 0 (0-20) in control group and 60 (40-100) in PONV group (P < 0.001). Postoperative nausea was assessed during 1 hr in post-anesthetic care unit. Blood samples were obtained before anesthesia and 1 hr after surgery. Plasma serotonin metabolite (5-hydroxy indole acetic acid, 5-HIAA) was analyzed using high performance liquid chromatography (HPLC) assay. Perioperative change of plasma 5-HIAA and Pro16Ser genotypes were compared between groups. RESULTS: Average 5-HIAA concentration of all patients increased after surgery (3.65 +/- 0.90 to 4.36 +/- 1.17 ng/ml, P < 0.001). Baseline plasma 5-HIAA concentrations were similar between groups, but, 5-HIAA of PONV group increased higher after laparoscopic surgery compared with control group (3.69 +/- 0.89 to 4.62 +/- 1.12 ng/ml vs. 3.61 +/- 0.93 to 4.10 +/- 1.20 ng/ml, P = 0.03). Pro16Ser genotypes were not different between groups. CONCLUSIONS: The patients who experienced post-operative nausea showed more increase in 5-HIAA concentration. PONV after gynecologic laparoscopic surgery may be associated with a peripheral release of serotonin.