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PubMed2004

Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drug therapy to prevent PONV is only partially effective. An alternative approach is to stimulate a P6 acupoint on the wrist. Although there are many trials examining this technique, the results are conflicting. OBJECTIVES: To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, Issue 1, 2003), MEDLINE (January 1966 to January 2003), EMBASE (January 1988 to January 2003) and the National Library of Medicine publication list of acupuncture studies up to and including January 2003. Reference lists of retrieved papers and reviews were consulted for additional references. SELECTION CRITERIA: All randomized trials of techniques that stimulated the P6 acupoint compared with: sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted the data. Primary outcomes were incidences of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects. A random effects model was used and relative risk (RR) with associated 95% confidence intervals (95% CI) are reported. Egger's test was used to measure the asymmetry of the funnel plot. MAIN RESULTS: Twenty-six trials (n = 3347) were included, none of which reported adequate allocation concealment. There were significant reductions in the risks of nausea (RR 0.72, 95% CI 0.59 to 0.89), vomiting (RR 0.71, 95% CI 0.56 to 0.91) and the need for rescue antiemetics (RR 0.76, 95% CI 0.58 to 1.00) in the P6 acupoint stimulation group compared with the sham treatment, although many of the trials were heterogeneous. There was no evidence of difference in the risk of nausea and vomiting in the P6 acupoint stimulation group versus individual antiemetic groups. However, when different antiemetics were pooled, there was significant reduction in the risk of nausea but not vomiting in the P6 acupoint stimulation group compared with the antiemetic group (RR 0.70, 95% CI 0.50 to 0.98; RR 0.92, 95% CI 0.65 to 1.29 respectively). The side effects associated with P6 acupoint stimulation were minor. There was some evidence of asymmetry of the funnel plot. REVIEWERS' CONCLUSIONS: This systematic review supports the use of P6 acupoint stimulation in patients without antiemetic prophylaxis. Compared with antiemetic prophylaxis, P6 acupoint stimulation seems to reduce the risk of nausea but not vomiting.

Acupuncture Points↗
PubMed2006

Inverse association between severe nausea and vomiting in pregnancy and some congenital abnormalities.

The objective of the study was to investigate the possible association between nausea and vomiting in early pregnancy and congenital abnormalities. The prevalence of medically-recorded severe nausea and vomiting in early pregnancy in cases with congenital abnormalities and their available matched population controls without any defect was compared in the population-based large data set of the Hungarian Case-Control Surveillance System of congenital abnormalities, 1980-1996. Of 22,843 cases with as 25 different congenital abnormality groups, 1,713 (7.5%) cases had mothers with medically recorded and treated severe nausea and vomiting during pregnancy. Of 38,151 matched population controls, 3,777 (9.9%) had mothers with severe nausea and vomiting (adjusted prevalence odds ratio (POR) with 95% CI: 0.74, 0.68-0.79). Five congenital abnormality groups: cleft lip with or without cleft palate (0.50, 0.37-0.70), posterior cleft palate (0.53, 0.32-0.89), renal a/dysgenesis (0.23, 0.06-0.96), obstructive defects of urinary tract (0.32, 0.18-0.58), and cardiovascular malformations (0.68, 0.57-0.81) had mothers with a lower prevalence of severe nausea and vomiting in pregnancy (adjusted PORs with 95% CI included in parentheses). Of 25 congenital abnormality groups, 22 had POR lower than 1. Thus in this study the mothers of cases with congenital abnormalities were 26% less likely to have had severe nausea and vomiting in early pregnancy than the mothers of population controls without congenital abnormalities.

Adult↗
PubMed1994

The area postrema and vomiting.

The area postrema (AP) has been implicated as a chemoreceptor trigger zone for vomiting (emesis) for over 40 years. The AP is located on the dorsal surface of the medulla oblongata at the caudal end of the fourth ventricle. It is one of the so-called circumventricular organs that serve as an interface between the brain parenchyma and the cerebrospinal fluid (CSF)-containing ventricles. The AP lacks a specific blood-brain diffusion barrier to large polar molecules (i.e., a "blood-brain barrier") and is thus anatomically positioned to detect emetic toxins in the blood as well as in the CSF. The AP along with the nucleus of the solitary tract (NTS) and the dorsal motor nucleus of the vagus makes up the so-called dorsal vagal complex, which is the major termination site of vagal afferent nerve fibers. Lesions of the AP prevent vomiting in response to most, but not all, emetic drugs. However, the AP is not essential for vomiting induced by motion or by activation of vagal nerve afferents. The role of the AP in radiation-induced vomiting remains controversial. Electrophysiological studies have reported that neurons in the AP increase their firing in response to emetic drugs. Similarly, studies using the 2-deoxyglucose uptake and c-fos expression techniques have shown that the AP is excited by systemic administration of emetic drugs. Activation of the AP probably leads to nausea and vomiting through its projection to the neighboring NTS. The NTS may serve as the beginning of a final common pathway by which different emetic inputs trigger vomiting.

Animals↗
PubMed1985

Studies on mechanism of retching and vomiting in dogs. Effect of peripheral dopamine blocker on myoelectric changes in antrum and upper small intestine.

In five conscious dogs prepared with a gastric cannula and platinum monopolar electrodes in the antrum, duodenum, and jejunum, the effect of dopamine or copper sulfate on the myoelectric activity was studied. During phase I of interdigestive myoelectric activity, retching, and/or vomiting occurred in 1.6 +/- 0.2 (mean +/- SE) min after intravenous bolus injection of dopamine (50 micrograms/kg) or in 8.7 +/- 1.8 min after intragastric administration of copper sulfate (2%, 50 mg). Immediately prior to the retching and/or vomiting act, a group of disordered myoelectric activities occurred, including retrograde-moving trains of spike activity starting from the jejunum and the subsequent tachyarrhythmia in the antrum. These motility changes also occurred in the two anesthetized dogs so studied. Both the retching and/or vomiting act and the abnormal myoelectric activity which were induced by dopamine and by copper sulfate were prevented by intravenous administration of a peripheral dopamine blocker, domperidone, 5 mg, in 100% and 70%, respectively. Although domperidone could not prevent the retching and/or vomiting induced by copper sulfate in three of 10 experiments, it delayed the onset of vomiting from 8.7 +/- 1.8 to 14.5 +/- 5.3 min. A possible role of peripheral dopamine receptor on the motility disorders associated with retching and/or vomiting has been suggested.

Animals↗
PubMed1996

Single high-dose dexamethasone improves the effect of ondansetron on acute chemotherapy-induced nausea and vomiting but impairs the control of delayed symptoms.

The introduction of serotonin receptor (5-HT3) antagonists has improved the control of acute nausea and vomiting induced by cancer chemotherapy, but they seem to have little or no effect on delayed symptoms. Corticosteroids are known to reduce both acute and delayed nausea and vomiting. The aim of the present study was to test the hypothesis that a single high dose of dexamethasone (20 mg), a long-acting corticosteroid, given after cisplatin and in addition to ondansetron (8 mg three times a day), would enhance the control of both acute and delayed nausea and vomiting. A group of 104 chemotherapy-naive ovarian cancer patients, scheduled for at least three cycles of combination chemotherapy including cisplatin (50 mg/m2), were randomly allocated to receive either dexamethasone or placebo in addition to ondansetron. Two-thirds of the patients received doxorubin and melphalan on the day before cisplatin and 1/3 received doxorubicin immediately before cisplatin. Unexpectedly we found, in all three chemotherapy cycles, that patients receiving dexamethasone suffered from more delayed nausea and vomiting than patients receiving placebo. In patients with no acute nausea or vomiting, the boomerang effect of dexamethasone could be seen on the first day after chemotherapy. In a follow-up study on 5 patients not included in the randomized trial, dexamethasone induced a pronounced reduction in urinary cortisol excretion on the day after chemotherapy with a return to normal excretion on day 2. It is concluded that a single high dose of dexamethasone does not seem appropriate for controlling delayed nausea and vomiting.

Antiemetics↗
PubMed1994

The menstrual cycle and nausea or vomiting after wisdom teeth extraction.

We have investigated 195 pre-menopausal women undergoing third molar extractions, in a prospective study, to assess the influence of the day of the menstrual cycle on the incidence of postoperative nausea or vomiting. In the 95 patients taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was higher on days 9 to 15 of the menstrual cycle (P < 0.05) than on days one to eight and days 16 to the end of cycle. In the 100 patients who were not taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was not higher on days 9 to 15. The strongest predictor for postoperative nausea or vomiting in our study was a previous episode of postoperative nausea or vomiting (P < 0.005). Patients with a tendency to motion sickness did not have a higher incidence of postoperative nausea or vomiting.

Adolescent↗
PubMed2006

Betamethasone does not prevent nausea and vomiting induced by the dopamine-agonist apomorphine.

PURPOSE: The mechanism of the antiemetic actions of corticosteroids is not known. The purpose of this study was to evaluate if betamethasone can prevent nausea, vomiting or increase of vasopressin induced by apomorphine. Metoclopramide, a dopamine antagonist, was used as a control substance. METHODS: Ten healthy volunteers were studied on three occasions. In a randomized order they were allocated to receive pretreatment with betamethasone 8 mg iv, metoclopramide 10 mg iv, and normal saline 2 mL as placebo on the three different occasions, 15 min before the administration of apomorphine 30 microg x kg(-1) s.c.. After administration of apomorphine, episodes of vomiting were recorded, and the intensity of nausea was estimated by the subject on a visual analogue scale (VAS 0-10 cm). Blood samples for analysis of plasma concentrations of vasopressin were analyzed. RESULTS: One volunteer decided to withdraw, as he experienced akathisia after receiving metoclopramide. During the first two hours after apomorphine, eight of nine volunteers vomited both after betamethasone and placebo. One volunteer did not vomit after betamethasone and placebo but he experienced nausea. None of the volunteers vomited after metoclopramide (P < 0.01 vs betamethasone and placebo). The maximum VAS for nausea was significantly higher after betamethasone and placebo compared to metoclopramide (P < 0.01). The vasopressin levels increased after betamethasone and placebo, but there was no increase in any volunteer after pretreatment with metoclopramide. CONCLUSION: This study demonstrates that betamethasone does not prevent nausea, vomiting and increase of vasopressin induced by apomorphine, whereas metoclopramide prevents apomorphine-induced emesis. Our work suggests that betamethasone does not have dopamine-antagonistic effects.

Adult↗
PubMed2004

Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting.

OBJECTIVE: Patients undergoing anaesthesia and surgery frequently complain about postoperative nausea and vomiting (PONV). Whether pretreatment with H1 and H2 blocking agents reduces the incidence of PONV remains controversial. To answer this question, we performed a randomised, prospective, placebo-controlled clinical study to evaluate the efficacy of a premedication with H1 and H2 receptor antagonists. MATERIAL AND SUBJECTS: 1149 patients (both sexes) undergoing surgery were randomly assigned to three treatment groups and one control group. Patients in the treatment groups were premedicated with the following H1 + H2 receptor antagonists:Group 1 (n = 335): 5 mg/kg cimetidine i.v. + 0.1 mg/kg dimetindene i.v. 20 min before induction of anaesthesiaGroup 2 (n = 337): 1.25 mg/kg ranitidine i.v. + 0.1 mg/kg dimetindene i.v. 20 min before induction of anaesthesiaGroup 3 (n = 316): 300 mg ranitidine p.o. + 0.1 mg/kg dimetindene i.v. 1 to 2 h before induction of anaesthesiaGroup 4 (n = 161): 20 ml saline solution i.v. 20 min before induction of anaesthesiaPatients from the treatment groups 1, 2 and 3 received regional or general anaesthesia depending on the clinical decision. All control patients received general anaesthesia consisting of fentanyl, a thiobarbiturate, enflurane, nitrous oxide, oxygen, and vecuronium. RESULTS: The incidence of nausea and vomiting was 8.5%, 6.8% and 5.4% in patients from the treatment groups (1, 2 and 3) who underwent general anaesthesia (n = 545), with no statistically significant differences between groups. The incidence of nausea and vomiting in the control group (n = 161) was 28.3% (nausea) and 27.5% (vomiting), respectively. In patients who underwent regional anaesthesia (n = 443), the incidence of nausea and vomiting was 2.5% and 1.1%, respectively. CONCLUSIONS: Premedication with H1 and H2 blocking agents significantly reduces the incidence of postoperative nausea and vomiting.

Adult↗
PubMed2000

[Tropisetron for prevention of nausea and vomiting in children undergoing tonsillectomy and/or adenoidectomy].

BACKGROUND: Postoperative nausea and vomiting (PONV) after tonsillectomy is a common problem in children. Tropisetron is a new 5HT3 receptor antagonist and is successfully used in paediatric patients receiving cancer therapy. The aim of the study was to assess efficacy and safety of a single intravenous dose of tropisetron for prevention of PONV in paediatric patients at risk for postoperative vomiting. METHODS: In a randomised, double-blind, placebo-controlled trial, we studied 98 children aged 2-12 years undergoing tonsillectomy or adenotonsillectomy. Patients received placebo or tropisetron 0.1 mg (= 0.1 ml)/kg body weight immediately after induction of anesthesia. A standard general anesthetic technique (Sevoflurane/N2O/O2 without neuromuscular blockers or opioids) was used. Perioperative vital signs, grade of sedation and episodes of postoperative nausea and vomiting were recorded. RESULTS: No vomiting episodes occurred in 65.3% of the tropisetron treated patients compared to 34.7% of the placebo group (p = 0.0024). Only 10.2% of the tropisetron treated patients vomited more than 3 times compared to 22.4% of the control patients (p = 0.0004). The need for antiemetic rescue medication was significantly lower in the study group (10.4%) compared to 28.6% (p = 0.025). No significant adverse effects of the study medication were shown. CONCLUSION: A single intravenous prophylactic dose of tropisetron effectively reduces the incidence of PONV during the first 24 postoperative hours after tonsillectomy and/or adenoidectomy. Because of the low incidence of adverse effects, the prophylactic use of tropisetron seems to be safe and justified in paediatric surgical patients at high risk for postoperative vomiting.

Adenoidectomy↗
PubMed2002

The infant with chronic vomiting: the value of the upper GI series.

BACKGROUND: Vomiting is very common in infants. It is usually attributed to gastroesophageal reflux and no radiological evaluation is performed. Pediatric radiologists, however, still perform many upper GI series in these infants to exclude an underlying anatomic abnormality as a cause for vomiting. OBJECTIVE: To evaluate the yield of upper GI series in the evaluation of otherwise healthy infants 1 month to 1 year of age with vomiting for more than 30 consecutive days. MATERIALS AND METHODS: Clinical records and upper GI reports of 344 otherwise healthy infants that were referred for UGI by pediatric gastroenterologists because of chronic vomiting were analyzed. Patients with hematemesis, bilious vomiting, dysphagia, respiratory symptoms and patients that required hospitalization were excluded. RESULTS: Findings other than gastroesophageal reflux were seen in only 2 patients out of 344 (0.6%). In one patient duodenal stenosis was diagnosed. In another patient a small hiatal hernia was seen. CONCLUSIONS: The yield of upper GI in otherwise healthy infants 1 month to 1 year of age with chronic vomiting is extremely low, and the performance of the UGI in this specific group of patients may not be justified.

Chronic Disease↗
PubMed2001

The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial.

This study was a randomised controlled trial designed to assess the effectiveness of progressive muscle relaxation training (PMRT) in the clinical management of chemotherapy-related nausea and vomiting as an adjuvant intervention to accompany pharmacological antiemetic treatment (metoclopramide and dexamethasone i.v.). Seventy-one chemotherapy-naive breast cancer patients of an outpatient oncology unit of a university hospital in Hong Kong participated, with 38 subjects randomised to the experimental group and 33 to the control group. The intervention included the use of PMRT 1 h before chemotherapy was administered and daily thereafter for another 5 days (for a total of six PMRT sessions). Each session lasted for 25 min and was followed by 5 min of imagery techniques. The instruments used for data collection included the Chinese versions of the Profile of Mood States and the State-Trait Anxiety Inventory (measured before chemotherapy and then at day 7 and day 14 after chemotherapy), and the Morrow Assessment of Nausea and Vomiting Scale, which was used daily for the first 7 post-chemotherapy days. The use of PMRT considerably decreased the duration of nausea and vomiting in the experimental group compared with the control group ( P<0.05), whereas there were trends toward a lower frequency of nausea and vomiting ( P=0.07 and P=0.08 respectively). Neither nausea nor vomiting differed in intensity between the two groups. The significant effects were mainly evident on the first 4 post-chemotherapy days, when differences were statistically significant. Although there was a significantly less severe overall mood disturbance in the experimental group over time ( P<0.05), this did not apply in the case of anxiety. Such findings suggest that PMRT is a useful adjuvant technique to complement antiemetics for chemotherapy-induced nausea and vomiting and that incorporation of such interventions in the care plan can enhance the standards of care of cancer patients who experience side effects of chemotherapy.

Adult↗
PubMed2005

Incidence of chemotherapy-induced nausea and vomiting in Taiwan: physicians' and nurses' estimation vs. patients' reported outcomes.

BACKGROUND: The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice. METHODS: Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naive patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score <5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2-5 after chemotherapy, respectively. RESULTS: In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists', residents', and nurses' estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naive patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively. CONCLUSIONS: Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.

Adult↗
PubMed1996

Ondansetron decreases postoperative vomiting in pediatric patients undergoing tonsillectomy and adenoidectomy.

One of the most frequently performed pediatric surgical procedures is tonsillectomy and adenoidectomy. Nausea and vomiting and the inability to tolerate oral fluids lead to unplanned hospitalizations. Despite treatment with metoclopramide and droperidol, nausea and vomiting continue to be high after this procedure. We designed this investigation to compare currently utilized antiemetics to ondansetron, a new serotonin antagonist, in hopes of decreasing the occurrence of nausea and vomiting in patients undergoing tonsillectomy and adenoidectomy. This prospective, randomized, double-blinded clinical trial compared ondansetron, droperidol, and placebo administered at the induction of general anesthesia and the incidence of vomiting postoperatively. One-hundred sixty-five children between the ages of 2 and 12 years undergoing ambulatory adenotonsillectomy were enrolled and completed this investigation. The primary outcome measure was the elimination of vomiting during the 24-h investigative period following surgery. Both ondansetron and droperidol significantly lowered the incidence of postoperative emesis after tonsillectomy and adenoidectomy (P < 0.012) compared to placebo. Ondansetron was significantly more effective than droperidol in reducing emesis after discharge (P < 0.025). Both ondansetron and droperidol are effective in decreasing emesis when given before surgical incision in pediatric patients undergoing tonsillectomy and adenoidectomy. Ondansetron's antiemetic effect persists for up to 24 h following surgery with significant reductions in emesis. Ondansetron's effectiveness in eliminating vomiting without sedation or other side effects suggests that it should be considered as part of the standard management in pediatric patients undergoing tonsillectomy and adenoidectomy.

Adenoidectomy↗
PubMed1983

Central nicotinic receptors: vomiting, ear twitching and panting.

Vomiting, ear twitching and panting produced by either nicotine or dimethylphenylpiperazinium (DMPP) administered intracerebroventricularly (ICV) to the unanesthetized cat were studied and compared. On a molar basis, nicotine evoked stronger effects overall in terms of the three responses studied, but the DMPP-induced vomiting and ear twitching responses, while weaker, were of longer duration. No significant differences were found in the duration of panting evoked by these nicotinic agonists. The nicotinic blocker hexamethonium injected ICV abolished the vomiting and ear twitching caused by either ICV nicotine or ICV DMPP, but vomiting and ear twitching persisted following the ICV administration of the muscarinic blocker, atropine. Both hexamethonium and atropine depressed or abolished the panting response evoked by either ICV nicotine or ICV DMPP. In cats with ablations of the area postrema, nicotine and DMPP injected ICV did not produce the vomiting response, but ear twitching and panting still occurred. It is concluded that the ICV injection of nicotine or DMPP evoked vomiting and ear twitching in the cat by way of an action on the central nicotinic receptors. However, panting produced by these nicotine agonists is mediated by the mimicking action of acetylcholine on central receptors having mixed nicotinic and muscarinic properties.

Animals↗
PubMed1986

Dimethylphenylpiperazinium-induced vomiting: nicotinic mediation in area postrema.

In unanesthetized cats the emetic action of dimethylphenylpiperazinium (DMPP) was investigated, after it was injected into the cerebral ventricles through chronically implanted cannulae. DMPP injected in 0.2-2.0 mg doses into the cerebral ventricle produced dose-dependent vomiting, which was abolished after ablation of area postrema. However, copper sulfate given intragastrically evoked vomiting in cats with an ablated area postrema. Further, the emetic response to ICV DMPP and to intragastric copper sulfate was depressed or abolished in cats pretreated with ICV reserpine. The emetic response to ICV DMPP, but not that caused by intragastric copper sulfate, was potentiated in cats pretreated with ICV 5,6-dihydroxytryptamine. Ganglionic blocking agents, mecamylamine and hexamethonium, injected ICV prevented the vomiting elicited by ICV DMPP. On the other hand, selected anti-muscarinic drugs, alpha and beta adrenergic antagonists, dopamine antagonists, antihistamines and a 5-hydroxytryptamine (5-HT) antagonist all injected into the cerebral ventricles had virtually no effect on the vomiting induced by DMPP. It is postulated that DMPP evokes vomiting by its action on nicotinic receptors of nerve cells within the area postrema but not on catecholaminergic, serotonergic, or cholinergic receptors. Finally, 5-HT and acetylcholine could also be involved in the inhibition of the complex mechanisms underlying the central regulation of vomiting.

Adrenergic alpha-Antagonists↗
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↗
PubMed1995

Anesthesia for magnetic resonance imaging in children: a low incidence of protracted post-procedure vomiting.

STUDY OBJECTIVE: To determine the incidence and severity of vomiting in pediatric patients who have had inhalation anesthesia for magnetic resonance imaging (MRI). DESIGN: A retrospective study of consecutive pediatric patients who had anesthesia for MRI. SETTING: A large university hospital with an integrated clinic facility. PATIENTS: 234 children who required an MRI under general anesthesia over a 30 month period (July 1989 to February 1992). MEASUREMENTS AND MAIN RESULTS: The duration of inhalation anesthesia was 105 +/- 33 minutes. Following anesthesia, the time to oral intake was 92 +/- 69 minutes. Eighteen patients (9%) experienced one or more episodes or emesis. In 14 of the 18 patients, vomiting occurred once and did not delay the intake of oral fluids or the discharge time from clinic when compared with the rest of the patients. Only one patient had frequent vomiting (more than three episodes), and all vomiting resolved spontaneously without anti-emetic therapy in less than eight hours following anesthesia. CONCLUSIONS: Protracted post-procedure vomiting is an infrequent complication of inhalation anesthesia for MRI. Inhalation anesthesia may be a less important cause of postoperative vomiting than factors such as the type of operative procedure, use of opioids, or presence of postoperative pain.

Anesthesia, Inhalation↗
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↗