A. Borgeat et al., GYNECOLOGIC LAPAROSCOPIC SURGERY IS NOT ASSOCIATED WITH AN INCREASE OF SEROTONIN METABOLITES EXCRETION, Anesthesia and analgesia, 87(5), 1998, pp. 1104-1108
Gynecologic laparoscopic surgery is associated with a high incidence o
f postoperative nausea and vomiting (PONV). The specific antagonists o
f the 5-hydroxytryptamine-3 (5-HT3) receptor have been progressively i
ntroduced in anesthesiology to prevent or treat PONV. Although a large
increase of serotonin has been documented after cisplatin treatment,
the link between serotonin and PONV in surgery/anesthesiology is unkno
wn. In a prospective study, we compared the excretion of the serotonin
metabolite 5-hydroxyindoacetic add (5-HIAA) in 40 women undergoing ei
ther gynecologic laparoscopic surgery (laparoscopy group) or tradition
al open laparotomy surgery (laparotomy group). Premedication, anesthet
ic technique, and postoperative pain treatment were standardized. The
excretion of 5-HIAA corrected to creatinine was measured in all patien
ts immediately after the induction of anesthesia and was repeated regu
larly until 9 h after induction. The excretion of 5-HIAA/creatinine wa
s similar in the two groups; no increase was observed in either group.
The incidence of nausea and vomiting was 40% and 35%, respectively in
the laparoscopy group versus 60% and 15%, respectively, in the laparo
tomy group (not significantly different). The excretion of 5-HIAA/crea
tinine was comparable in patients of both groups among those who vomit
ed and those who did not. We conclude that the creation of a pneumoper
itoneum during gynecologic laparoscopic surgery is not associated with
an increase of 5-HIAA excretion. PONV after gynecologic laparoscopic
surgery is not explained by an increase of serotonin secretion. Implic
ations: The mechanism leading to the high incidence of postoperative n
ausea and vomiting after gynecologic laparoscopic surgery is unknown.
The excretion of the serotonin metabolite 5-hydroxyindoacetic acid did
not increase during the creation of the pneumoperitoneum and the firs
t 9 h postoperatively. Increase of serotonin secretion from the gut ma
y not explain postoperative nausea and vomiting associated with this s
urgery.