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Cardiac Tumors

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Question of the Day

A 45-year-old, otherwise healthy woman with past anesthetic history significant for postoperative nausea and vomiting is in the recovery room after laparoscopic cholecystectomy. She received intraoperative dexamethasone, ondansetron, and transdermal scopolamine. Despite these drugs, she complains of nausea. You are contemplating the use of propofol in the recovery period for treatment of her nausea. Propofol exerts its antiemetic effects at which of the following sites in the central nervous system?

Question of the Day
A 45-year-old, otherwise healthy woman with past anesthetic history significant for postoperative nausea and vomiting is in the recovery room after laparoscopic cholecystectomy. She received intraoperative dexamethasone, ondansetron, and transdermal scopolamine. Despite these drugs, she complains of nausea. You are contemplating the use of propofol in the recovery period for treatment of her nausea. Propofol exerts its antiemetic effects at which of the following sites in the central nervous system?
Your Answer
Correct Answer

Explanation

The proposed site of action for propofol’s sedative and anesthetic effects is the GABA receptor. Propofol binds to GABA receptors in the brainstem-thalamocortical arousal circuits as well as the hippocampus to achieve hypnosis and sedation. Propofol also inhibits the glutamate receptor subtype of NMDA receptors and has direct depressant effects on the spinal cord. The euphoria associated with the use of propofol is attributed to the increase in dopamine in the nucleus accumbens. The antiemetic effects of propofol are attributed to reduction in serotonin in the area postrema, likely through an effect on GABA receptors.

References:

Postoperative Nausea and Vomiting in Adults

Vuyk J, Sitsen E, and Reekers M. Intravenous Anesthetics, In: Miller’s Anesthesia, 8th ed. ebook. St. Louis, MO: Elsevier Saunders; 2015: Ch. 30; pp. 825-6

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