Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery

Abstract

A high incidence of plasma histamine release was demonstrated in most but not all patients with POV. The probability of POV with histamine release (0.5) was higher than without histamine release (0.3), thus histamine release was shown to be one of the contributory determinants for POV in this clinical study. Thus, patients at risk for POV may benefit from a H1 + H2-receptor antagonists prophylaxis alone or in combination with other antiemetic strategies.

Safety and efficacy of commonly used antiemetics

“…route has good absorption with effective plasma concentrations reached within 3 h of dosing [8]. But it is also important to note that histamine levels alone do not predict if a patient will experience postoperative nausea [9].…”

Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting

“…More recently, cyclizine (H 1 receptor antagonist) proved to be at least as effective as ondansetron in preventing PONV after gynaecological laparoscopy and was even superior to ondansetron concerning the use of rescue antiemetics in patients undergoing diagnostic laparoscopy [18]. A recently published study investigating changes in the mediator levels of histamine and serotonin metabolites after gynaecological laparoscopy demonstrate an association between these changes in mediator levels and PONV [19,20]. In accordance with these results, a recently published metaanalysis showed that dimenhydrinate, another H 1 antagonist with some antimuscarinic activity, has a similar efficacy with respect to the prophylaxis of PONV when compared to more common antiemetics such as 5HT 3 antagonists and droperidol [2,21].…”

Fentanyl-induced cough is a risk factor for postoperative nausea and vomiting

“…19 20 Histamine release can be associated with bouts of postoperative vomiting. 19 Histamine H1 receptor antagonists, including diphenhydramine and cyclizine, are more effective than placebo in preventing PONV. [21][22][23] In different studies, H1 receptor antagonists were as effective 22 or less effective 24 than serotonin 5HT-3 receptor antagonists in preventing PONV.…”