Abstract
BackgroundThe opioid remifentanil induces a decrease of vestibulo-ocular reflex function, which has been associated with nausea and vomiting when the subjects are moved. The study investigates in healthy female volunteers if immobility after remifentanil administration protects from nausea and vomiting.MethodsIn volunteers, a standardized movement intervention (a manually applied head-trunk movement forward, backward and sideward) was started 5 min (session A), 35 min (session B) or 60 min (session C) after cessation of a remifentanil infusion (0.15 μg · kg−1 · min−1). In a cross-over design, 16 participants were randomized to the early (sessions A and B) or the late intervention group (sessions A and C). Nausea was assessed using a 11-point numerical rating scale before and after each movement intervention. Differences within and between groups were assessed with non-parametric tests for paired and unpaired data.ResultsComparing sessions A, B and C, intensity of nausea was time-dependent after cessation of remifentanil administration (p = 0.015). In the early intervention group, nausea decreased from median 5.0 [IQR 1.5;6.0] in session A to 2.0 [1.0;3.0] in session B (p = 0.094); in the late intervention group nausea decreased from 3.5 [2.0;5.0] in session A to 0.5 [0.0;2.0] in session C (p = 0.031).ConclusionsIn summary, in young healthy women, immobility after remifentanil administration protects from nausea and vomiting in a time-dependent manner. In analogy to motion sickness, opioid-induced nausea and vomiting in female volunteers can be triggered by movement.Trial registrationGerman Clinical Trials Register DRKS00010667. The trial was registered retrospectively on June, 20th 2016.
Highlights
The opioid remifentanil induces a decrease of vestibulo-ocular reflex function, which has been associated with nausea and vomiting when the subjects are moved
The vestibular system has been identified to contribute to postoperative nausea and vomiting (PONV) and this is reflected by the simplified risk score for predicting PONV after general anaesthesia [10]
We showed that the opioid remifentanil induces a decrease of vestibulo-ocular reflex (VOR) function [13]
Summary
The opioid remifentanil induces a decrease of vestibulo-ocular reflex function, which has been associated with nausea and vomiting when the subjects are moved. The study investigates in healthy female volunteers if immobility after remifentanil administration protects from nausea and vomiting. Efferent fibers reach the vomiting center, along with input from three other major areas, namely: the gastrointestinal tract, the cerebral cortex and the vestibular apparatus [12]. We showed that the opioid remifentanil induces a decrease of vestibulo-ocular reflex (VOR) function [13]. The calculated half-life time of the recovery of the VOR function after cessation of the remifentanil administration was 5.3 min [13]. Movement has been found to trigger nausea, while immobility protected from nausea. We suggested that the intersensory mismatch caused by the impaired VOR promotes nausea and vomiting
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