Perioperative use of centrally acting angiotensin-converting enzyme inhibitor may increase patients' risk for postoperative nausea and vomiting.

Abstract Substance P (SP) is involved in the development of postoperative nausea and vomiting (PONV). It is hydrolyzed by angiotensin-converting enzyme (ACE). Centrally acting ACE inhibitors (CACE-Is) are widely used in the perioperative period. The current evidence showed CACE-Is could upregulate SP level in the central nervous system which may contribute to the occurrence of PONV in 0–72h. Here, we present our hypothesis that the use of CACE-Is in the perioperative period may increase patients' risk for both early (0–24h) and late (24–72h) PONV. The identification of this new risk factor may improve patients' risk assessment and thus lead to better prophylaxis strategies for PONV that are base on risk stratification.