Acta Anaesthesiol Scand 2007; 51: 217–225 Printed in Singapore. All rights reserved # 2006 The Authors Journal compilation # 2006 Acta Anaesthesiol Scand ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/j.1399-6576.2006.01179.x Does esomeprazole prevent post-operative nausea and vomiting? J. RAEDER 1 ,V.DAHL 2 , E. BJOERNESTAD 3 , G. EDLUND 4 , S. MODIN 5 , E. NAUCLER 6 , R. BERGHEIM 7 and J. KILHAMN 6 1 Department of Anaesthesia, Aleris Hospital AS/University of Oslo, Oslo, 2 Department of Anaesthesia/Intensive Care, Sykehuset Asker and Baerum HF, RUD, 3 Department of Surgery, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway , 4 Department of Surgery; O ¨ stersunds Hospital, O ¨ stersund, 5 Department of Surgery, Ka ¨rnsjukhuset, Sko ¨vde, 6 AstraZeneca R&D, Mo ¨lndal, Sweden and 7 Medical Department, AstraZeneca AS, Oslo, Norway Background: Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esome- prazole on reducing post-operative nausea and vomiting (PONV). Methods: Patients undergoing laparoscopic or open gynaecolog- ical surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either eso- meprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen includ- ing fentanyl and sevoflurane/nitrous oxide. Results: The study population consisted of 284 patients. Demo- graphic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0–24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after lapa- roscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the low- est risk when corrected for other risk factors of PONV. Conclusion: Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration. Accepted for publication 21 August 2006 Key words: esomeprazole; PONV; neostigmine; vomiting; aspiration; surgery. # 2006 The Authors Journal compilation # 2006 Acta Anaesthesiol Scand P OST-OPERATIVE nausea and vomiting (PONV) is still one of the most frequent complaints and sources of distress after surgery under general anaes- thesia (1). However, research during the past decade has identified patients who may be especially at risk for PONV and are thus potential candidates for receiving antiemetic prophylaxis (2, 3). Whereas many types of drugs have proven efficacy for anti- emetic prophylaxis, the potential benefit of a single modality is at best a 20–30% reduction in the incidence of PONV (4). By combining drugs, the antiemetic efficacy may be improved (4). In this context, it is of interest to look for new drug modalities that may contribute to a prophylactic antiemetic effect without undue side-effects. By virtue of their ability to reduce both intragas- tric acidity and gastric juice volume, proton pump inhibitors (PPIs) have been advocated for pre- anaesthetic use to reduce the volume and acidity of any clinically important aspiration (5). This may lead to a reduction in pulmonary damage caused by regurgitation or vomiting. However, PPIs may also have a potential antiemetic effect, as receptors in the gastric wall are known to play a role in the sensation of nausea by mediating input via the vagal nerve to the nausea-vomiting centre in the midbrain (6). There have been a few anecdotal reports that esomeprazole has an antiemetic effect (7), which initiated a smaller prospective study with no antiemetic effect demon- strated (7). The present study is the first large-scale dedicated prospective study on the clinical anti- emetic usefulness of esomeprazole in the peri- operative setting, with a secondary aim of looking at concomitant peri-operative risk factors. 217