PubMed · 11686039
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M Markman. 2001. Supportive care.. https://pubmed.ncbi.nlm.nih.gov/11686039/
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With the introduction of newer antineoplastic agents, the challenge for supportive care is enlarging. For the most part, these targeted therapies are given in addition to more classic anticancer drugs, either in combination or in sequence, underscoring the need for prevention of emesis and attention to all treatment toxicities. Strategies for preventing these side effects need to be investigated while appropriately addressing more familiar problems such as emesis. Two directions for improving emetic control are clear. First is the development of newer antiemetics that enhance current control rates, and second is the proper use of existing agents in all emetic settings. This report outlines the rationale behind the development of neurokinin type 1 antagonists, and reviews consensus recommendations in the prevention of acute and delayed emesis.
UNLABELLED: The peripherally acting prokinetic drug cisapride can overcome opioid-induced gastrointestinal paresis and may thereby eliminate a stimulus for postoperative vomiting. We conducted a prospective, randomized, double-blinded, controlled trial of 96 children undergoing inguinal surgery to determine whether cisapride would reduce the incidence of postoperative vomiting after general anesthesia supplemented with morphine. Group C1 patients (n = 38) received cisapride 0.3 mg/kg orally 1 h before surgery and placebo 6 h later, Group C2 (n = 28) received cisapride both before and after surgery, and Group P (n = 30) received placebo. Mean age (5.0 +/- 2.7 yr) and weight (21.0 +/- 8.6 kg), median pain scores and parent satisfaction scores, and incidence of rescue analgesic administration were similar across groups. Contrary to our hypothesis, incidences of postoperative vomiting in the hospital (32% vs 20%, P = 0.33) and at home (53% vs 46%, P = 0.33) did not vary by treatment group (with [C1 and C2] and without [P] cisapride, respectively). There was a trend toward more severe postoperative vomiting (three or more episodes) in children who received cisapride versus those who did not, both in hospital (6% vs 0%, P = 0.3) and at home (22% vs 8%) (P = 0.13). We conclude that cisapride does not prevent postoperative vomiting in this patient population and speculate that factors other than reduced gastrointestinal motility associated with general anesthesia and opioids are more important determinants of postoperative vomiting. IMPLICATIONS: Cisapride does not prevent postoperative vomiting in children and may increase its severity.