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Related Concept Videos

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Chemotherapy-Induced Nausea and Vomiting: Cannabinoids01:21

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
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Pathophysiology of Vomiting01:22

Pathophysiology of Vomiting

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Vomiting is a complex physiological response to expel harmful or irritating substances from the body. It's a defensive mechanism triggered by stimuli like poisons, microbial toxins, cytotoxic drugs, and mechanical abdominal distension. The process is centrally coordinated by the vomiting (or emetic) center located in the medulla of the brainstem. This area, rich in muscarinic M1, histamine H1, neurokinin 1 (NK1), and serotonin 5-HT3 receptors, coordinates the act of vomiting through...
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Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists01:23

Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists

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Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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5-Hydroxytryptamine and postoperative nausea and vomiting after microvascular decompression surgery.

Yuantao Hou1, Hansheng Liang1, Cungang Fan2

  • 1Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|August 19, 2023
PubMed
Summary

Elevated cerebrospinal fluid 5-hydroxytryptamine (5-HT) levels are linked to postoperative nausea and vomiting (PONV) after microvascular decompression surgery. This finding identifies a key risk factor for PONV in these patients.

Keywords:
Hemifacial spasmMicrovascular decompression surgeryNauseaSerotoninVomiting

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Neuroscience

Background:

  • Postoperative nausea and vomiting (PONV) is a common complication following microvascular decompression (MVD) surgery.
  • The exact mechanisms driving PONV after MVD remain unclear.
  • Elevated serum 5-hydroxytryptamine (5-HT) is observed in PONV patients, but its role in MVD-related PONV is unknown.

Purpose of the Study:

  • To investigate the association between 5-hydroxytryptamine (5-HT) levels and the incidence of PONV in patients undergoing MVD surgery.
  • To identify potential biomarkers for predicting PONV risk after MVD.

Main Methods:

  • Prospective study of 85 patients undergoing MVD for hemifacial spasm.
  • Measurement of 5-HT levels in serum and cerebrospinal fluid (CSF) using ELISA.
  • Evaluation of PONV incidence and severity at 2, 6, and 24 hours post-surgery.

Main Results:

  • Elevated CSF 5-HT levels were significantly associated with PONV within 24 hours after MVD (OR=1.21, p=0.044).
  • Reduction in intraocular pressure was also linked to PONV (OR=11.54, p=0.022).
  • Receiver operating characteristic analysis showed high predictive accuracy (AUC=0.873, p<0.001).

Conclusions:

  • Cerebrospinal fluid 5-HT levels represent an independent risk factor for PONV following MVD surgery.
  • CSF 5-HT may serve as a predictive biomarker for PONV in this patient population.