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

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 0-72 h. 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 (24-72 h) 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.