Amaya Sebastian, Kalsotra Sidhant, Tobias Joseph D, Olbrecht Vanessa A
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
Saudi J Anaesth. 2023 Jul-Sep;17(3):383-390. doi: 10.4103/sja.sja_151_23. Epub 2023 Jun 22.
Isopropyl alcohol (IA) is a colorless, flammable organic compound that has been used in the manufacturing process of a wide variety of industrial and household chemicals. Inhalation of its vapor has been noted to potentially have antiemetic effects, which may be useful in the treatment of postoperative nausea and vomiting (PONV). However, given the varied study protocols and endpoints assessing its efficacy as antiemetic, clinical trials have yielded mixed results. If effective, inhalation of IA may be a cost-effective, readily available, and inexpensive therapy that can be used for the treatment of PONV with a low risk of adverse effects. The following narrative review explores the available information regarding the mechanism of action of IA in treating PONV, presents clinical information including possible mechanism of action and clinical applications, and reviews the published literature on its efficacy to treat nausea and vomiting with a focus on its use postoperatively. While early studies suggested that inhaled IA may be successful for the short-term treatment of PONV compared with placebo, subsequent studies both in and out of the operating room (OR) have reported conflicting results. In general, studies in the perioperative setting have provided some evidence to support the use of inhaled IA in alleviating or reducing the severity of PONV in adults. In particular, inhaled IA may have a more rapid onset compared with traditional antiemetic agents, but the clinical effect has generally been found to be short-lived. The results outside of the OR and perioperative setting have been somewhat more favorable, generally showing that inhaled IA reduces nausea and vomiting of various etiologies in adults in the emergency department setting. Similarly, it has been shown to reduce the need for rescue antiemetic agents in this area and thus may be considered a cost-cutting strategy with no reported adverse effects. The available literature suggests that inhaled IA may be considered a potential therapy to achieve rapid relief of PONV and assist in the management of nausea and vomiting in adult patients outside of the perioperative setting. There remain insufficient data to determine how inhaled IA may impact PONV in children. Given the mixed results and the limitations of the current studies, additional data are needed to draw firm conclusions regarding the utility of inhaled IA.
异丙醇（IA）是一种无色、易燃的有机化合物，已被用于多种工业和家用化学品的制造过程中。吸入其蒸汽已被注意到可能具有止吐作用，这可能对治疗术后恶心和呕吐（PONV）有用。然而，鉴于评估其作为止吐药疗效的研究方案和终点各不相同，临床试验结果不一。如果有效，吸入IA可能是一种具有成本效益、容易获得且价格低廉的治疗方法，可用于治疗PONV，且不良反应风险较低。以下叙述性综述探讨了关于IA治疗PONV作用机制的现有信息，介绍了包括可能的作用机制和临床应用在内的临床信息，并回顾了关于其治疗恶心和呕吐疗效的已发表文献，重点是其在术后的使用。虽然早期研究表明，与安慰剂相比，吸入IA可能成功用于PONV的短期治疗，但随后在手术室（OR）内外进行的研究报告了相互矛盾的结果。一般来说，围手术期的研究提供了一些证据支持使用吸入IA来减轻或降低成人PONV的严重程度。特别是，与传统止吐药相比，吸入IA的起效可能更快，但通常发现临床效果是短暂的。手术室和围手术期以外的研究结果则更为有利，总体表明吸入IA可减少急诊科成人各种病因引起的恶心和呕吐。同样，在这方面已证明它可减少使用急救止吐药的需求，因此可被视为一种削减成本的策略，且未报告有不良反应。现有文献表明，吸入IA可被视为一种潜在的治疗方法，以实现快速缓解PONV，并有助于管理围手术期以外成年患者的恶心和呕吐。目前仍没有足够的数据来确定吸入IA如何影响儿童的PONV。鉴于结果不一以及当前研究的局限性，需要更多数据才能就吸入IA的效用得出确凿结论。
