Gastric Branch Of Vagus Nerve Research Articles

Predominant role of gut-vagus-brain neuronal pathway in postoperative nausea and vomiting: evidence from an observational cohort study

BackgroundPostoperative nausea and vomiting (PONV) as a clinically most common postoperative complication requires multimodal antiemetic medications targeting at a wide range of neurotransmitter pathways. Lacking of neurobiological mechanism makes this ‘big little problem’ still unresolved. We aim to investigate whether gut-vagus-brain reflex generally considered as one of four typical emetic neuronal pathways might be the primary mediator of PONV.MethodsThree thousand two hundred twenty-three patients who underwent vagus nerve trunk resection (esophagectomy and gastrectomy) and non-vagotomy surgery (hepatectomy, pulmonary lobectomy and colorectomy) from December 2016 to January 2019 were enrolled. Thirty cases of gastrectomy with selective resection on the gastric branch of vagus nerve were also recruited. Nausea and intensity of vomiting was recorded within 24 h after the operation.ResultsPONV occurred in 11.9% of 1187 patients who underwent vagus nerve trunk resection and 28.7% of 2036 non-vagotomy patients respectively. Propensity score matching showed that vagotomy surgeries accounted for 19.9% of the whole PONV incidence, much less than that observed in the non-PONV group (35.1%, P < 0.01). Multivariate logistic regression result revealed that vagotomy was one of underlying factor that significantly involved in PONV (OR = 0.302, 95% CI, 0.237-0.386). Nausea was reported in 5.9% ~ 8.6% vagotomy and 12 ~ 17% non-vagotomy patients. Most vomiting were mild, being approximately 3% in vagotomy and 8 ~ 13% in non-vagotomy patients, while sever vomiting was much less experienced. Furthermore, lower PONV occurrence (10%) was also observed in gastrectomy undergoing selective vagotomy.ConclusionPatients undergoing surgeries with vagotomy developed less PONV, suggesting that vagus nerve dependent gut-brain signaling might mainly contribute to PONV.

SALIVARY RESPONSE TO STIMULATION OF GASTRIC BRANCHES OF VAGUS NERVE.

In adult cats anesthetized with ether and immobilized with Flaxedil, submaxillary salivation was elicited following electrical stimulation of the central cut ends of the dorsal and ventral gastric branches of the vagus nerve. This response was abolished when the lingual nerve was severed above the terminal branching of the chorda tympani. Ipsilateral or contralateral section of the vagus nerve in the neck had no effect on the salivary response; however, it disappeared completely when the vagi were cut bilaterally. This shows that the visceral afferents mediating this response, from either gastric branch of the vagus, travel centrally in both vagi. These studies demonstrate a feedback circuit from the stomach to the salivary glands.