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PubMed1989

The acute onset of nausea and vomiting following stereotactic radiosurgery: correlation with total dose to area postrema.

From 1986 to 1988, 44 patients have been treated for tumors or vascular lesions with stereotactic radiosurgery using a modified standard linear accelerator. In seven patients, nausea and vomiting occurred within 6 hours after the completion of radiosurgery. One of these patients with nausea and occasional vomiting pretreatment had exacerbation several hours after treatment, in spite of droperidol and prochlorperazine prophylaxis. Nausea and vomiting in the other six patients was self-limited and was completely resolved by 12 hours from onset. None of these six patients suffered from nausea and vomiting before treatment. This was directly correlated with the total dose to the vomiting center in the floor of the fourth ventricle (area postrema). The median dose to the vomiting center in the seven patients was 618 cGy (range 275-1257). The final patient in the series received 1088 cGy to the area postrema after droperidol and dexamethasone prophylaxis without developing nausea or vomiting. In the remaining 36 patients who received from less than 5 to 184 cGy to area postrema, nausea and vomiting did not occur. We recommend that patients treated with large fractions of radiation by radiosurgery in this area be premedicated appropriately.

Brain Neoplasms↗
PubMed1991

Predicting development of anticipatory nausea in cancer patients: prospective examination of eight clinical characteristics.

An algorithm based on learning theory and previous research for predicting which cancer patients would develop nausea in anticipation of chemotherapy treatments was tested. Patients with four or more of the following eight characteristics after their first treatment were predicted to develop anticipatory nausea (AN) by their fourth chemotherapy treatment: experienced nausea and/or vomiting after first treatment; nausea after treatment described as "moderate, severe, or intolerable;" vomiting after treatment described as "moderate, severe, or intolerable;" less than 50 yr of age; a susceptibilty to motion sickness; feeling warm or hot all over after treatment; sweating following treatment; feelings of generalized weakness following treatment. The characteristics significantly predicted subsequent anticipatory nausea development (p less than .01) by their fourth treatment in 355 consecutive cancer patients. Results were independent of the type of cancer being treated. The accuracy of the prediction was less specific than prior research, 34% of patients predicted to develop AN did so, compared to 16% of the total sample. Results are consistent with a learned etiology for the development of anticipatory side effects and support the importance of predictive methodologies in investigating mechanisms of anticipatory nausea development.

Antineoplastic Agents↗
PubMedDate not supplied

Nitrous oxide, nausea, and vomiting after outpatient gynecologic surgery.

Postanesthetic nausea and vomiting can delay discharge of outpatients and can cause occasional admissions to hospital. Nitrous oxide (N2O) has been thought to increase this frequency, but previous studies have been indecisive. One hundred eighty-five unpremedicated outpatients undergoing laparoscopic tubal ligation were studied to determine the effect of N2O on postanesthetic nausea and vomiting. The patients were divided by registration number, intubated, and given mixtures of either N2O-O2 enflurane or air-O2 enflurane. Intravenous (IV) lidocaine, administered initially prior to intubation to control bucking, was later omitted in randomly chosen cases to determine its effect. The overall prevalence of nausea and vomiting was 29.2% with N2O and 9.3% with air (p less than 0.001). While the lidocaine subseries was small, it appeared to prevent nausea and vomiting, particularly when N2O was omitted. Further study is justified. Fentanyl, given postoperatively for pain, did not increase the prevalence of nausea and vomiting. It was concluded that N2O is associated with an increased prevalence of nausea and vomiting.

Adult↗
PubMed1994

Efficacy and tolerability of tropisetron in comparison with a combination of tropisetron and dexamethasone in the control of nausea and vomiting induced by cisplatin-containing chemotherapy.

In a double-blind, randomised, multicentre study, the efficacy and tolerability of tropisetron and a combination of tropisetron and dexamethasone were compared for the control of nausea and vomiting induced by cisplatin in patients previously not entirely protected by tropisetron monotherapy. In all, 160 women with gynaecological cancers were studied during two consecutive courses of cisplatin-containing chemotherapy. During the first course (the screening course), all patients received tropisetron monotherapy [5 mg intravenous (i.v.) on day 1 and 5 mg orally on days 2-6] as antiemetic treatment. During the second course (the test course), tropisetron was compared with a combination of tropisetron and dexamethasone (20 mg i.v. on day 1 and 4.5 mg twice daily on days 2-6). This part of the study was double-blind, randomised and placebo-controlled. Candidates for randomisation were patients with partial control of nausea (< 12 h of nausea) or partial control of vomiting (1-4 episodes of vomiting) during the screening course. Patients with complete control of nausea and vomiting in the screening course continued with tropisetron monotherapy; patients with treatment failure received open rescue treatment in course 2. Total control of acute nausea was achieved in 37% of the tropisetron + placebo group and in 75% of the tropisetron + dexamethasone group (P = 0.001). Significantly more patients on tropisetron-dexamethasone than on tropisetron-placebo were also free of delayed nausea. Acute vomiting was prevented in 40% of the patients in the placebo group and in 75% in the dexamethasone group (P = 0.001). Delayed vomiting was also significantly less frequent in dexamethasone-treated patients than in placebo-treated patients. Tropisetron was well tolerated both as monotherapy and in combination with dexamethasone. The most frequent adverse events were headache (34%), constipation (12.5%) and fatigue (12.5%). Adding high doses of a corticosteroid did not induce further adverse events or disregulate concurrent diseases.

Adult↗
PubMed2006

The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis.

OBJECTIVE: The aim of this study was to specifically determine the impact of a fixed dose of ginger administration, compared with placebo, on the 24-hour postoperative nausea and vomiting. STUDY DESIGN: The design was a systematic review and metaanalysis of trials revealed by searches. Randomized controlled trials comparing ginger with placebo to prevent postoperative nausea and vomiting and postoperative vomiting from Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles, contact of authors, and experts in the field. Two reviewers selected studies for inclusion and independently extracted data. RESULTS: Five randomized trials including a total of 363 patients were pooled for analysis of preventing postoperative nausea and vomiting and postoperative vomiting. The summary relative risks of ginger for postoperative nausea and vomiting and postoperative vomiting were 0.69 (95% confidence interval 0.54 to 0.89) and 0.61 (95% confidence interval 0.45 to 0.84), respectively. Only one side effect, abdominal discomfort, was reported. CONCLUSIONS: This meta-analysis demonstrates that a fixed dose at least 1 g of ginger is more effective than placebo for the prevention of postoperative nausea and vomiting and postoperative vomiting. Use of ginger is an effective means for reducing postoperative nausea and vomiting.

Zingiber officinale↗
PubMed2006

Endocrine correlates of acute nausea and vomiting.

This paper gives an overview of studies investigating endocrine changes in acute nausea and vomiting. The aetiology of nausea and vomiting is not fully understood, but it has been shown that different stress hormones are released into circulation during motion sickness. Studies with animals and humans have shown that acute nausea activates the hypothalamo-pituitary-adrenal axis and the neurohypophyseal system. So-called stress hormones, like adrenocorticotropic hormone, cortisol, and antidiuretic hormone, are released concomitant with nausea and vomiting in motion sickness, but do not seem to be involved in the aetiology of motion sickness. Nevertheless, plasma levels of stress hormones more or less correlate to the intensity of nausea related symptoms. Although gastroenteropancreatic hormones are involved in gastrointestinal motility, there are only few data describing their changes in response to acute nausea or vomiting.

Animals↗
PubMed2006

Postoperative nausea and vomiting.

Nausea and vomiting following surgery may either occur as postoperative nausea and vomiting, which is a condition that is mainly related to anesthesia, or as secondary to postoperative ileus, which denotes inhibition of gastrointestinal motility following surgery. Postoperative ileus is a multifactorial event with several contributing mechanisms. Although postoperative nausea and vomiting pathophysiology has been quite well-studied little is known about it. There are multiple targets for treatment, prevention, and its successful empirical management e.g. by 5-HT(3) receptor antagonists. This review describes different aspects of the pathophysiology of postoperative ileus and postoperative nausea and vomiting, their relevance to postoperative care, and the standardized approach to manage postoperative nausea and vomiting that was established by Apfel and coworkers. Despite the recent advances in the understanding and treatment of conditions that trigger nausea and vomiting in the postoperative period, these symptoms remain a significant problem that affects patients' recovery, comfort, and treatment cost.

Antiemetics↗
PubMed2006

Functional cortical imaging of nausea and vomiting: a possible approach.

From a naive point of view, a study on functional cortical imaging of nausea and vomiting should deliver insight into the basic cortical mechanisms, connections, and time courses, of nausea and vomiting as perceived and processed in the human brain of affected subjects. Until now the brain's response to nausea and vomiting are only inadequately characterized, because studies have been focused mostly on understanding the different mechanisms leading to nausea rather than to cortical activations during nausea or vomiting, respectively. Consequently, the imaging of the "personal experience" of nausea and vomiting can currently be regarded as terra incognita. Nonetheless, the wide variety of the results published on diverse aspects of the topic can be helpful in providing guidelines for a paradigm to further investigations. This paper presents a brief outline for a study on the functional imaging of nauseated humans by means of functional magnetic resonance imaging (fMRI).

Brain Mapping↗
PubMed2005

Acustimulation wrist bands are not effective for the control of chemotherapy-induced nausea in women with breast cancer.

This experiment examined the efficacy of an acustimulation wrist band for the relief of chemotherapy-induced nausea using a randomized three-arm clinical trial (active acustimulation, sham acustimulation, and no acustimulation) in 96 women with breast cancer who experienced nausea at their first chemotherapy treatment. Five outcomes related to wrist band efficacy (acute nausea, delayed nausea, vomiting, QOL, and total amount of antiemetic medication used) were examined. The five outcomes were examined separately using analysis of covariance controlling for age and severity of past nausea. There were no significant differences in any of these study measures among the three treatment conditions (P>0.1 for all). Study results do not support the hypothesis that acustimulation bands are efficacious as an adjunct to pharmacological antiemetics for control of chemotherapy-related nausea in female breast cancer patients.

Acupuncture Therapy↗
PubMed2000

Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy.

BACKGROUND: Postoperative nausea and vomiting is a common problem in patients undergoing laparoscopic cholecystectomy (LC). The purpose of this study was to evaluate the efficacy of ondansetron given at the induction of anesthesia in patients scheduled for ambulatory LC. METHODS: A total of 84 patients undergoing ambulatory LC were enrolled in a randomized, prospective, double-blinded study in which the subjects received either placebo or 4 mg ondansetron intravenously at induction of anesthesia. A nausea scoring system was employed utilizing a 5-point linear scale, with 1 point given for no nausea and a maximum of 5 points for an episode of emesis. Each patient received a total of four scores postoperatively. RESULTS: The patients receiving placebo had significantly more episodes of nausea (53 versus 32; P <0.009) and emesis (11 versus 2; P <0.02), higher mean total nausea scores (7.2 versus 5.4; P <0.006), and need for additional postoperative antiemetics (23 versus 14; P <0.05) than those receiving ondansetron. CONCLUSIONS: In patients undergoing ambulatory laparoscopic cholecystectomy, ondansetron at induction was highly effective in decreasing postoperative nausea and vomiting and should become the standard.

Adult↗
PubMed1988

Apomorphine-induced nausea in humans: release of vasopressin and pancreatic polypeptide.

Based on studies in animals and humans, it has been suggested that nausea activates the hypothalamo-neurohypophyseal system with resultant increases in circulating concentrations of oxytocin or vasopressin. The purpose of these studies was to determine in humans whether nausea is associated with increases in circulating concentrations of neurohypophyseal hormones or various enteropancreatic peptides (vasoactive intestinal polypeptide, substance P, or pancreatic polypeptide). Nausea, induced by intravenous infusion of apomorphine, was associated with fivefold to 75-fold increases in plasma vasopressin concentrations in 7 subjects (mean increase, 41-fold), with no change in plasma oxytocin levels. Furthermore, nausea was associated with sevenfold to 16-fold increases in plasma pancreatic polypeptide concentrations (mean increase, ninefold), with no change in plasma levels of vasoactive intestinal polypeptide or substance P. In 1 subject refractory to nausea, there was no increase in plasma vasopressin or pancreatic polypeptide concentrations with apomorphine. These studies indicate that nausea in humans is associated with vasopressin and pancreatic polypeptide release.

Adult↗
PubMed2001

Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial.

OBJECTIVE: To determine the effectiveness of ginger for the treatment of nausea and vomiting of pregnancy. METHODS: Women with nausea and vomiting of pregnancy, who first attended an antenatal clinic at or before 17 weeks' gestation, were invited to participate in the study. During a 5-month period, 70 eligible women gave consent and were randomized in a double-masked design to receive either oral ginger 1 g per day or an identical placebo for 4 days. Subjects graded the severity of their nausea using visual analog scales and recorded the number of vomiting episodes in the previous 24 hours before treatment, and again during 4 consecutive days while taking treatment. At a follow-up visit 7 days later, five-item Likert scales were used to assess the severity of their symptoms. RESULTS: All participants except three in the placebo group remained in the study. The visual analog scores of posttherapy minus baseline nausea decreased significantly in the ginger group (2.1 +/- 1.9) compared with the placebo group (0.9 +/- 2.2, P =.014). The number of vomiting episodes also decreased significantly in the ginger group (1.4 +/- 1.3) compared with the placebo group (0.3 +/- 1.1, P <.001). Likert scales showed that 28 of 32 in the ginger group had improvement in nausea symptoms compared with 10 of 35 in the placebo group (P <.001). No adverse effect of ginger on pregnancy outcome was detected. CONCLUSION: Ginger is effective for relieving the severity of nausea and vomiting of pregnancy.

Administration, Oral↗
PubMed2001

Temperature effect on nausea during fluorescein angiography.

PURPOSE: Nausea is the most common adverse effect of fluorescein angiography (FA). Warming of fluorescein dye before injection has been reported anecdotally to decrease nausea frequency. We examined the effect of warmed fluorescein dye on the frequency of adverse effects of FA. DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS: Five hundred forty-seven angiograms performed on 394 patients; 273 were in the control group and 274 were in the study group. METHODS: Patients were alternately assigned to FA using dye at room temperature (control group) or dye prewarmed to body temperature (study group). All patients were masked to the dye temperature. After FA, patients were questioned regarding any adverse effects experienced. MAIN OUTCOME MEASURES: Presence or absence of reported nausea associated with FA. RESULTS: Adverse reactions were reported for 39 of the angiograms (7.1%), including 32 procedures for which nausea was reported (5.9%). No significant difference in the frequency of adverse reactions was found between the two groups (P = 0.41). No significant difference in the frequency of nausea was found between the two groups (P = 0.28). The sample sizes used allow an 80% power for detecting a clinically significant difference of 4% adverse effects in one group and 10% in the other group when testing at a significance level of 5%. CONCLUSIONS: Warming of fluorescein dye does not significantly alter the incidence of nausea reported with FA.

Female↗
PubMed1998

Ondansetron versus droperidol or placebo to prevent nausea and vomiting after otologic surgery.

This study compares the preoperative administration of ondansetron with that of droperidol or saline solution for the prevention of nausea and vomiting in otologic surgery patients. A total of 120 otherwise healthy individuals were randomly assigned to receive either saline solution, ondansetron (4 mg intravenously), or droperidol (25 microg/kg intravenously) before anesthetic induction. Intraoperative and postanesthesia care unit times were recorded along with incidence of nausea, vomiting, pain, nausea and recovery scores, and the administration of rescue antiemetics. Similar assessments were made during the next 24 hours. Demographics were similar, but more males received ondansetron. Anesthetic recovery scores were lower after administration of droperidol than after ondansetron. Incidence of nausea was similar between groups, but severity was greater with placebo and droperidol than with ondansetron. More vomiting occurred with placebo than with ondansetron or droperidol. No intergroup differences in rescue antiemetic administration were noted, however. Twenty-four hours later, more patients receiving placebo had nausea or vomited than patients receiving droperidol or ondansetron. Fewer women in the ondansetron group vomited than in the other two groups. Ondansetron 4 mg intravenously is as effective as droperidol and better than saline solution in preventing nausea and vomiting in patients undergoing otologic surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter postanesthesia care unit times was noted after ondansetron therapy.

Adult↗
PubMed1999

The effect of preoperative ondansetron on the incidence of postoperative nausea and vomiting in patients undergoing outpatient dentoalveolar surgery and general anesthesia.

PURPOSE: The purpose of this investigation was to evaluate the efficacy of ondansetron in controlling postoperative nausea and vomiting (PONV) when used prophylactically in patients undergoing routine dentoalveolar surgery performed under general anesthesia. PATIENT AND METHODS: This was a prospective, double-blind, randomized, placebo-controlled evaluation. Fifty adult ASA I or II patients, requiring routine dentoalveolar surgery performed under general anesthesia, without a prior history of PONV, were randomly assigned to the experimental or control groups. Ondansetron (2.0 mL = 4.0 mg) or normal saline (2.0 mL) were administered intravenously before surgery. Age, gender, type of surgery, duration of surgery, anesthetic dosages, and PONV were evaluated. PONV was evaluated at time 0 (end of anesthesia) and at 30 and 60 minutes postoperatively. Nausea was evaluated using a visual analog scale (1, not nauseous; 5, about to vomit). Vomiting was assessed as a yes or no response. At 20 to 28 hours postoperatively, PONV was evaluated via a telephone call as a yes or no response, along with the number of episodes of nausea, vomiting, or both. Means and standard deviations were calculated for age, surgery, and anesthetics, and differences were assessed using an independent samples t-test. Differences for gender between the control and experimental groups were tested by a nonparametric chi-squared test. Differences between groups for nausea and vomiting were tested with a continuity correction chi-squared test. Differences were considered significant for a P < .05. RESULTS: No significant differences (P < .05) were found between the PONV groups for gender, duration of procedure, or anesthetic dosages. Statistically significant differences were noted in age and the type of surgical procedures performed. No statistically significant differences (P < .05) were noted between groups for nausea or vomiting. CONCLUSION: Based on the results of this study, PONV occurred in approximately 20% of patients (20% for nausea, 8% for vomiting). With the types of anesthetic agents and techniques used in this investigation, there were no significant differences between ondansetron and placebo for prophylaxis against PONV.

Adolescent↗
PubMed1992

[Prevention of postoperative nausea and vomiting by ondansetron].

This study was carried out to assess the efficacy of oral ondansetron, a new 5HT3 receptor antagonist, in patients undergoing thyroid surgery. It included 60 patients, randomly assigned to two groups, and receiving orally, 1 h before induction of anaesthesia, either 8 mg of ondansetron (n = 29) or a placebo (n = 30). One patient was excluded. The same anaesthetic protocol, consisting of 3 to 5 micrograms.kg-1 of fentanyl, 4 to 6 mg.kg-1 of thiopentone, and 0.5 mg.kg-1 of atracurium, was used in all. Anaesthesia was maintained with 50% nitrous oxide in oxygen with 0.8 to 1% endtidal concentration of isoflurane and additional boluses of 0.1 mg of fentanyl as required. The incidence and intensity of nausea, graded mild, moderate or severe, and the incidence of vomiting were recorded postoperatively. During the first twelve hours after surgery, 40% of patients in the placebo group had nausea (16.7% mild, 20% moderate and 6.7% severe), and 50% vomited. In the ondansetron group, nausea and vomiting occurred in 13.8% and 20.4% of patients respectively. The 4 patients in the latter group complained of major nausea. The differences between the groups were statistically significant: p = 0.025 for nausea and p = 0.042 for vomiting. It is concluded that oral ondansetron, 8 mg taken orally 1 h before surgery, significantly reduces the incidence of nausea and vomiting during the first twelve postoperative hours. As it is easy to use and has no side-effects, it might be of interest in day-case surgery patients, despite its high cost.

Administration, Oral↗
PubMed2001

The role of patients' expectations in the development of anticipatory nausea related to chemotherapy for cancer.

Although anticipatory nausea (AN), which is reported by one-third of patients receiving chemotherapy for cancer, is thought to develop primarily by classical conditioning, response expectancies may also be important. The role of patients' expectations of nausea in the development of AN was examined in 63 female cancer patients receiving their first course of chemotherapy. Twenty women (32%) expected to experience nausea and twelve (19%) reported AN before the third cycle. Pretreatment expectations predicted AN at cycle three (Spearman's r = 0.41, P = 0.001). AN developed in 40% of patients who expected nausea, 13% of those who were uncertain whether they would develop it, and no patients who did not expect nausea. Logistic regression indicated that expecting nausea was the strongest predictor (chi(2) =13.15; P < 0.001). Results support a role for cognitive factors in the development of chemotherapy side effects and suggest testing psychologic interventions to modify patients' expectations.

Adult↗
PubMed2002

Treatment of nausea and emesis during cancer chemotherapy. Discrepancies between antiemetic effect and well-being.

The purpose of this study was to describe the relationship between antiemetic effect and well-being in patients receiving four different antiemetic treatment strategies, representing developments in the field during the past 15 years. A total of 162 women with ovarian cancer receiving cisplatin-based chemotherapy and participating in two comparative antiemetic trials were enrolled and studied for up to four cycles. In study I, a combined antiemetic strategy including a nursing intervention program (increased access to support and increased information) and antiemetics based on high-dose metoclopramide and dexamethasone was compared with the standard antiemetic treatment during the 1980s. In study II, ondansetron plus dexamethasone/placebo was evaluated. The assessment methods used were similar for all patients. Questionnaires were used to assess frequency, intensity, and duration of nausea, emesis, anxiety, pain, and well-being at baseline, and for acute (24 hours after chemotherapy) and delayed (up to 2 weeks after chemotherapy) symptoms. The mean intensity of acute nausea during the first cycle was higher in the groups in study I, as compared to the groups in study II. The group receiving a nursing intervention reported better well-being than the other groups. Duration of nausea was an important predictor of well-being, even when nausea intensity was controlled. Apart from nausea intensity, nausea duration and nursing interventions may be important determinants for well-being during chemotherapy.

Drug-Related Side Effects and Adverse Reactions↗