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At least 253 records · Page 14Linked to original sources
PubMed2003

Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo.

BACKGROUND: Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting. METHODS: Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea. RESULTS: The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008]. CONCLUSION: We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.

Adult↗
PubMed2005

Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data.

This review examines the evidence from published data concerning the tolerability (indicated by the incidence of nausea, vomiting, sedation, pruritus, and urinary retention), of three analgesic techniques after major surgery; intramuscular analgesia (i.m.), patient-controlled analgesia (PCA), and epidural analgesia. A MEDLINE search of publications concerned with the management of postoperative pain and these indicators identified over 800 original papers and reviews. Of these, data were extracted from 183 studies relating to postoperative nausea and vomiting, 89 relating to sedation, 166 relating to pruritus, and 94 relating to urinary retention, giving pooled data which represent a total of more than 100,000 patients. The overall mean (95% CI) incidence of nausea was 25.2 (19.3-32.1)% and of emesis was 20.2 (17.5-23.2)% for all three analgesic techniques. PCA was associated with the highest incidence of nausea but the emesis was unaffected by analgesic technique. There was considerable variability in the criteria used for defining sedation. The overall mean for mild sedation was 23.9 (23-24.8)% and for excessive sedation was 2.6 (2.3-2.8)% for all three analgesic techniques (significantly lower with epidural analgesia). The overall mean incidence of pruritus was 14.7 (11.9-18.1)% for all three analgesic techniques (lowest with i.m. analgesia). Urinary retention occurred in 23.0 (17.3-29.9)% of patients (highest with epidural analgesia). The incidence of nausea and excessive sedation decreased over the period 1980-99, but the incidence of vomiting, pruritus, and urinary retention did not. From these published data it is possible to set standards of care after major surgery for nausea 25%, vomiting 20%, minor sedation 24%, excessive sedation 2.6%, pruritus 14.7%, and urinary retention requiring catheterization 23%. Acute Pain Services should aim for incidences less than this standard of care.

Analgesia↗
PubMed1999

Nausea during pregnancy and congenital heart defects: a population-based case-control study.

The authors investigated the possible association between a mother's nausea during pregnancy and her child's risk for a congenital heart defect using data from the population-based Atlanta Birth Defects Case-Control Study conducted in 1982-1983. Case infants (n = 998) had nonsyndromic congenital heart defects and control infants (n = 3,029) had no congenital defects. Nausea during pregnancy (NP) was graded in eight levels of "severity" based on its onset, frequency, and duration. Level 1, the most severe NP, was associated with a lower risk for a congenital heart defect in the child (odds ratio (OR) = 0.81, 95% confidence interval (CI) 0.67-0.99) compared with no nausea. The lower risk tended to disappear with less severe levels of nausea, and the trend was statistically significant. Overall, early NP (levels 1 to 4 combined) with use of antinausea medication, particularly Bendectin (doxylamine, dicyclomine (dropped from the formulation in 1976), pyridoxine (vitamin B6)), was associated with a lower risk for congenital heart defects compared with: 1) absence of nausea (OR = 0.67, 95% CI 0.50-0.92), and 2) nausea without medication use (OR = 0.70, 95% CI 0.50-0.94). The results suggest that pregnancy hormones and factors or, alternatively, a component of Bendectin (most probably pyridoxine) may be important for normal heart development. These findings outline potential areas for future research on and prevention of congenital heart defects.

Adolescent↗
PubMed1988

The association of reproductive history, demographic factors, and alcohol and tobacco consumption with the risk of developing nausea and vomiting in early pregnancy.

The role of maternal risk factors in the development of nausea and vomiting in pregnancy was studied in a historical cohort of 825 women who gave birth at the University of California (Los Angeles) Medical Center during a one-year period (April 1983-March 1984). The roles of demographic factors, reproductive history, and consumption of alcohol and tobacco in affecting the risk of developing nausea and vomiting were studied using both bivariate and multivariate statistical methods. Interpretations of the statistical analyses identify three risk factor associations correlated with decreased risk of nausea and vomiting and one factor associated with increased risk. The most apparent pattern was that women who were ethnically white, of white collar or professional occupation, and who consumed alcohol prior to conception, were at decreased risk for nausea and vomiting. The second pattern of decreased risk consisted of women over 35 years old with a history of infertility for one or more years prior to the current conception. The third low-risk pattern consisted of women without a history of nausea during prior pregnancies. The only factor associated with an increased risk was housewife occupational status. The results of this study are consistent with an endocrinologic model for the etiology of pregnancy-induced nausea and vomiting.

Adolescent↗
PubMed1997

Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.

Nausea and vomiting occur frequently during cesarean section under spinal anesthesia. Metoclopramide reduces intraoperative nausea and vomiting, but not without potential side effects. Acupressure, a noninvasive variation of acupuncture that involves constant pressure on the wrist, has been suggested as an alternative method to prevent nausea and vomiting. The aim of this study was to compare acupressure and intravenous (IV) metoclopramide for the prevention of nausea and vomiting during elective cesarean section under spinal anesthesia. Seventy-five patients were studied in a randomized, prospective, double-blind comparative trial. Group I patients received acupressure bands + 2 mLIV saline, Group II patients received placebo wrist bands + 10 mg IV metoclopramide, and Group III patients received placebo wrist bands + 2 mL IV saline. Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group. Acupressure is an effective, non-pharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient.

Acupressure↗
PubMed1997

Intravenous ondansetron for postsurgical opioid-induced nausea and vomiting. S3A-255 Study Group.

The use of opioids for postoperative analgesia may be limited by side effects such as nausea and vomiting. Because ondansetron, a selective serotonin type 3 (5-hydroxytryptamine [5-HT3]) antagonist, is effective for chemotherapy and general anesthesia-induced nausea and vomiting, we hypothesized that it may also be effective for opioid-induced nausea and vomiting. ASA physical status I-III patients undergoing regional anesthesia were eligible for the study. Those who requested an antiemetic after postsurgical opioid administration were randomized to receive a single dose of ondansetron (0.1 mg, 4 mg, or 16 mg intravenously [I.V.]) or placebo in a double-blind fashion. Emetic episodes, nausea and pain ratings, and adverse events were recorded for 24 h after study drug administration. Patient satisfaction scores were obtained 24 h after study drug infusion. A significantly (P < 0.05) larger proportion of patients treated with ondansetron 4 mg and 16 mg experienced no emetic episodes, received no rescue antiemetic, and completed the study compared with placebo. Nausea scores and patient satisfaction scores in the ondansetron 16-mg group were significantly (P < 0.05) more favorable than in the placebo group. Postsurgical pain scores did not differ among groups. The incidence of adverse events was similarly low across groups. The results of this study support our hypothesis that I.V. ondansetron is effective for postsurgical opioid-induced nausea and vomiting.

Adult↗
PubMed1999

Dexamethasone decreases epidural morphine-related nausea and vomiting.

UNLABELLED: The aim of our study was to compare the antiemetic effect of IV dexamethasone with saline control in preventing epidural morphine-related nausea and vomiting. Eighty patients requiring epidural anesthesia for abdominal total hysterectomy were enrolled in a randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg for relief of postoperative pain. Before the morphine injection, the dexamethasone group (n = 40) received IV dexamethasone 8 mg, whereas the saline group (n = 40) received IV saline. We found that the incidence of postoperative vomiting was 5% in the dexamethasone group and 25% in the saline group (P<0.05). The total incidence of nausea and vomiting was 16% in the dexamethasone group and 56% in the saline group (P<0.001). IV dexamethasone 8 mg significantly decreases the incidence of epidural morphine-related nausea and vomiting. IMPLICATIONS: We evaluated IV dexamethasone versus saline control in preventing epidural morphine-related nausea and vomiting in patients receiving epidural morphine for postoperative pain control. We found that IV dexamethasone significantly decreased the total incidence of nausea and vomiting after epidural morphine. IV dexamethasone may be a valuable treatment for preventing epidural morphine-related nausea and vomiting.

Adult↗
PubMed2000

Preoperative anxiety and postoperative nausea and vomiting in children: is there an association?

UNLABELLED: We performed a cross-sectional study to explore a potential association between preoperative anxiety and postoperative nausea and vomiting (PONV). The study enrolled 51 unpremedicated children 5-16 yr old undergoing outpatient surgery and standardized general anesthesia. Anxiety of children was assessed in the preoperative holding area and during the induction of anesthesia. The incidence of nausea and vomiting was documented in the postanesthesia care unit (PACU) and 24 h postoperatively (POD#1). In addition to univariate analysis, we used multivariate logistic regression models, wherein the dependent variable was the presence or absence of PONV and the independent variables included potential confounders such as age, sex, and perioperative opioid consumption. Univariate analysis showed that children who experienced nausea (32 +/- 5 vs 31 +/- 4, P = ns) or vomiting (32 +/- 4 vs 32 +/- 5, P = ns) in the PACU did not differ significantly in their anxiety before surgery. A multivariate model, in which the dependent variable was the presence or absence of vomiting at POD#1 and the independent variables included preoperative anxiety, age, sex, and opioid consumption, indicated that preoperative anxiety does not predict the occurrence of nausea and vomiting (P = ns). We conclude that children's anxiety in the preoperative holding area has no predictive value for the occurrence of PONV in the PACU or POD#1. IMPLICATIONS: This study was performed to explore a possible association between children's anxiety before surgery and postoperative nausea and vomiting. We found that controlling for confounding variables, anxiety in the preoperative holding area has no predictive value for the occurrence of postoperative nausea and vomiting.

Adolescent↗
PubMed2002

The prophylactic effect of tropisetron on epidural morphine-related nausea and vomiting: a comparison of dexamethasone with saline.

UNLABELLED: Tropisetron is a 5-hydroxytryptamine subtype 3 receptor antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. We evaluated the prophylactic effect of tropisetron on postoperative nausea and vomiting associated with epidural morphine. Dexamethasone and saline served as controls. One-hundred twenty women (n = 40 in each of three groups) undergoing abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blinded, and placebo-controlled study. At the end of surgery, Group 1 received IV tropisetron 5 mg, whereas Groups 2 and 3 received dexamethasone 5 mg and saline, respectively. We found that tropisetron did not significantly reduce the occurrence of nausea and vomiting associated with epidural morphine. Dexamethasone, however, reduced the total incidence of nausea and vomiting from 59% to 21% (P < 0.01) and the percentage of patients requiring rescue antiemetic from 38% to 13% (P < 0.05). We conclude that IV tropisetron 5 mg did not prevent the occurrence of postoperative nausea and vomiting associated with epidural morphine. IV dexamethasone 5 mg was effective for this purpose. IMPLICATIONS: We compared the prophylactic IV administration of tropisetron 5 mg to prevent postoperative nausea and vomiting (PONV) associated with epidural morphine with dexamethasone 5 mg and saline in women undergoing hysterectomy. We found that tropisetron 5 mg did not significantly reduce the occurrence of PONV associated with epidural morphine. Dexamethasone 5 mg was effective for this purpose.

Adult↗
PubMed1993

Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron.

BACKGROUND: Postoperative nausea and vomiting following outpatient surgery can significantly delay discharge. This study evaluates the safety and efficacy of ondansetron (a new 5-HT3 antagonist) in the treatment of postoperative nausea and vomiting in patients following outpatient surgery. METHODS: Five hundred outpatient surgical patients (53 male and 447 female), receiving general endotracheal anesthesia, were studied at ten centers. Patients were stratified by gender and received, in a randomized, double-blind manner, 1, 4, or 8 mg ondansetron or placebo in response to nausea and/or vomiting postoperatively. Episodes of vomiting, nausea scores, adverse events, vital signs, and laboratory values were evaluated before and during the 24 h after study drug administration. RESULTS: Complete response to study medication (no vomiting and/or retching, and no rescue antiemetic over the initial 0-2-h period) was more frequent in the ondansetron groups (1 mg 57%, 4 mg 61%, and 8 mg 57%) than in the placebo group (30%, P < .001). For the 0-24-h study a complete response occurred in only 15% of the placebo group compared to 41%, 47%, and 47% of the 1-, 4-, and 8-mg ondansetron groups, respectively (P < .001 for all comparisons with placebo). Median nausea scores (range 0-10) during the initial observation period (0-2 h) were significantly lower for all doses of ondansetron (1.3, 0.8, 1.8 for 1, 4, and 8 mg, respectively) as compared with placebo (2.3). No significant differences occurred in hemodynamic stability, incidence of adverse events, or changes in laboratory values in the ondansetron groups compared to the placebo group. CONCLUSIONS: Ondansetron, in doses less than 8 mg, is a safe, effective antiemetic for treating postoperative nausea and vomiting.

Adult↗
PubMed1993

Menstruation increases the risk of nausea and vomiting after laparoscopy. A prospective randomized study.

BACKGROUND: Several factors may influence the incidences of postoperative nausea and vomiting. In women, one of these factors may be the timing of their surgery in relation to their menstrual cycle. The purpose of this study was to assess the effect of menstruation and efficacy of the antiemetic droperidol on postoperative nausea and vomiting. METHODS: In a prospective randomized double-blind clinical trial, 100 female patients who were scheduled for laparoscopic tubal sterilization were stratified on the basis of the date of their last menses into menstrual (days 1-8) and nonmenstrual (days 9-28) groups. Patients in both groups were then randomized to receive placebo or 10, 20, or 30 micrograms/kg droperidol before induction of anesthesia, and data were obtained for 24 h after completion of their surgery. RESULTS: Nausea and vomiting were reported in 55 patients, and the risk was 2.92 times greater in the menstrual group (71.4%) than in the nonmenstrual group (46.2%; (P = .013). Droperidol (30 micrograms/kg) reduced the incidence of vomiting from 47.1% (placebo) to 13.3% in the nonmenstrual group (P = .045) but had no effect in the menstrual group. Five prognostic variables (menstrual stratum, droperidol, age 30 yr or younger, weight 65 kg or less, and history of nausea and vomiting) for postoperative nausea and vomiting were tested by stepwise logistic regression. Menstrual stratum was the only variable identified as a significant (P = .017) predictor, having a percent probability equal to 2.21. CONCLUSIONS: The risk of postoperative nausea and vomiting is increased in women undergoing laparoscopic tubal sterilization during the first 8 days of their menstrual cycle, and droperidol up to 30 micrograms/kg is not as effective in these patients.

Adult↗
PubMed1996

Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting.

BACKGROUND: Breast surgery is associated with a high incidence of postoperative nausea and vomiting. Propofol and prophylactic administration of ondansetron are associated with a lower incidence of postoperative nausea and vomiting. To date no comparison of these two drugs has been reported. A randomized study was done to compare the efficacy of ondansetron and intraoperative propofol given in various regimens. METHODS: Study participants included 89 women classified as American Society of Anesthesiologists physical status 1 or 2 who were scheduled for major breast surgery. Patients were randomly assigned to one of four groups. Group O received 4 mg ondansetron in 10 ml 0.9% saline and groups PI, PIP, and PP received 10 ml 0.9% saline before anesthesia induction. Group O received thiopental, isoflurane, nitrous oxide-oxygen, and fentanyl for anesthesia. Group PI received propofol, isoflurane, nitrous oxide-oxygen, and fentanyl. Group PIP received propofol, isoflurane, nitrous oxide-oxygen, and fentanyl. Thirty minutes before expected skin closure, isoflurane was discontinued and 50 to 150 micrograms.kg-1.min-1 propofol was given intravenously to maintain anesthesia. Group PP received propofol for induction and maintenance of anesthesia, nitrous oxide-oxygen, and fentanyl. Postoperative pain relief was provided with morphine administered by a patient-controlled analgesia pump. The incidence of nausea and vomiting, requests for rescue antiemetic and sedation, pain scores, and hemodynamic data were recorded for 24 h. RESULTS: Within 6 h of surgery, groups O and PP had a lower incidence of nausea compared with groups PI and PIP (P < 0.05). Fewer patients in group PP (19%) vomited during the 24-h period compared with groups O (48%), PI (64%), and PIP (52%) (P < 0.05). The incidence of antiemetic use was also less in group PP (P < 0.05). Patients in group PP had lower sedation scores at 30 min and at 1 h (P < 0.05). There were no differences among the groups in pain scores, blood pressure, heart rate, respiratory rate, and incidence of pruritus. CONCLUSIONS: Propofol administered to induce and maintain anesthesia is more effective than ondansetron (with thiopental-isoflurane anesthesia) in preventing postoperative vomiting and is associated with fewer requests for rescue antiemetic and sedation in the early phase of recovery. It is equally effective in preventing postoperative nausea as ondansetron in the first 6 h after operation. Propofol used only as an induction agent or for induction and at the end of surgery were not as protective against postoperative nausea and vomiting.

Adult↗
PubMed2005

The impact of pharmacogenomics on postoperative nausea and vomiting: do CYP2D6 allele copy number and polymorphisms affect the success or failure of ondansetron prophylaxis?

BACKGROUND: Some patients treated with ondansetron for postoperative nausea and vomiting do not respond to therapy. One possible mechanism for this failure is ultrarapid drug metabolism via the cytochrome P-450 system, specifically the enzyme 2D6 (CYP2D6). Ultrarapid metabolism is seen in patients with multiple functional copies (>/= 3) of the CYP2D6 allele. This study was designed to determine whether patients who were given prophylactic ondansetron and had multiple CYP2D6 alleles had an increased rate of postoperative nausea and vomiting. METHODS: Two hundred fifty female patients undergoing standardized general anesthesia were given 4 mg ondansetron 30 min before extubation. Patients were observed for symptoms of nausea and vomiting. DNA was extracted from blood in all patients and was analyzed by using a gene-specific probe to determine the CYP2D6 gene copy number and genotyped by polymerase chain reaction amplification with a custom oligonucleotide microarray to determine the specific CYP2D6 genotypes. RESULTS: Eighty-eight patients experienced nausea, and 37 of those patients also had vomiting. In patients with one, two, or three CYP2D6 copies, the incidences of vomiting were 3 in 33 (27%), 27 in 198 (14%), and 7 in 23 (30%), respectively. The incidence of vomiting in subjects with three CYP2D6 copies was significantly different from those with two copies, but not from those with one copy. When analyzed by genotype, the incidences of vomiting in poor, intermediate, extensive, and ultrarapid metabolizers were 1 in 12 (8%), 5 in 30 (17%), 26 in 176 (15%), and 5 in 11 (45%), respectively (P < 0.01 vs. all other groups). There were no differences between groups in the incidence of nausea based on CYP2D6 copy number or genotype. CONCLUSIONS: Patients with three copies of the CYP2D6 gene, a genotype consistent with ultrarapid metabolism, or both have an increased incidence of ondansetron failure for the prevention of postoperative vomiting but not nausea.

Adolescent↗
PubMedDate not supplied

The pathophysiology of chemotherapy-induced nausea and vomiting.

Chemotherapy-induced nausea and vomiting is a major debilitating side effect of oncology treatment despite recent advances in pharmaceutical management. Nurses who provide care to patients experiencing nausea and vomiting are often only marginally aware of the pathophysiological processes involved in the treatment. A better understanding of the science behind current interventions to reduce nausea and vomiting may help nurses use those interventions more effectively. This article reviews current knowledge about the pathophysiology of chemotherapy-induced nausea and vomiting. By understanding the pathophysiology behind this patient experience, gastroenterology nurses can develop a better understanding of the common symptoms of nausea and vomiting in general. When a nurse understands the complexity of factors causing nausea and vomiting, he or she will be better able to provide appropriate interventions to reduce these symptoms.

Antiemetics↗
PubMed1991

Double-blind randomized cross-over trial comparing methylprednisolone with placebo in chemotherapy-induced nausea and vomiting: a study with special reference to efficacy parameters.

Sixty-one patients with breast cancer who received chemotherapy participated in a double-blind randomized cross-over study with methylprednisolone (MP) 250 mg as a single i.v. injection before chemotherapy and placebo as antiemetic treatment. The determining efficacy parameter was preference. Other parameters used were a visual analogue scale for nausea, a categorical four-point nausea intensity scale recorded by a nurse observer, emetic amounts, emetic episodes, acceptance of nausea and vomiting, and global assessments for nausea and vomiting. MP showed a significant antiemetic effect compared with placebo which was most pronounced for moderately emetogenic chemotherapy. The visual analogue scale, emetic amounts, acceptance and global assessments were easy to handle and showed coherence with preference, whereas nausea intensity and emetic episodes were resource demanding to record and showed no coherence with preference. It is concluded that for a precise evaluation of nausea and vomiting the visual analogue scale and emetic amounts are most reliable; for ambulatory patients global assessments seem to be sufficient.

Adult↗
PubMed1999

Transcutaneous electrical nerve stimulation as an adjunct for controlling chemotherapy-induced nausea and vomiting in gynecologic oncology patients.

BACKGROUND: To evaluate the efficacy of a miniaturized portable transcutaneous electrical nerve stimulation (TENS) unit (ReliefBand) as an adjunct to standard antiemetic therapy for controlling nausea and vomiting induced by cisplatin-based chemotherapy in gynecologic oncology patients. METHODS: Forty-two patients were enrolled in a randomized, double-blind, placebo-controlled parallel-subjects trial with a follow-up crossover trial. All patients received a standardized antiemetic protocol, then wore the ReliefBand continuously for 7 days. RESULTS: Thirty-two patients were evaluable for the parallel-subjects component, 16 in each group. The percentage of patients with absent or minimal nausea was 59% overall, which was similar to that for both the active (56%) and placebo (62%) groups. The incidence and severity of nausea and vomiting was similar for each group. Eighteen patients completed two consecutive cycles and were evaluable for the crossover component. The average age of the crossover patients and their dose intensity were comparable with those of the overall study population (56.3 versus 58.6 years and 22.7 versus 22.7 mg/m2/week, respectively). The percentage of cycles with absent or minimal nausea was 47% overall, which was similar to that of the active (50%) and placebo (44%) cycles. However, the severity of nausea was significantly lower in the active cycles during days 2 to 4. Patients averaged less than one episode of vomiting daily in each cycle. CONCLUSIONS: The ReliefBand is an effective adjunct to standard antiemetic agents for controlling nausea induced by cisplatin-based chemotherapy in gynecologic oncology patients.

Antiemetics↗
PubMed1980

Pretreatment nausea in cancer chemotherapy: a conditioned response?

Many patients receiving cancer chemotherapy become nauseated as they anticipate their treatments. We studied this phenomenon in eighteen cancer chemotherapy patients. The eight patients who reported pretreatment nausea had more extensive disease than the other patients and had received twice as much chemotherapy. In most cases pretreatment nausea developed only a after a number of months of treatment. Nausea was usually precipitated by the odor of the clinic and similar odors elsewhere also caused nausea. Patients continued to experience nausea during follow-up visits after treatment was completed. This syndrome of pretreatment nausea can be understood as a classically conditioned response. Clinical recommendations can be made on this basis.

Adult↗
PubMedDate not supplied

Noradrenergic activity in anticipatory nausea.

Two studies were conducted to examine the hypothesis that noradrenergic activity is a cause of the anticipatory nausea associated with cancer chemotherapy. In the first study concentrations of plasma 3-methoxy-4-hydroxyphenyl-glycol (MHPG) on day 1 of cycle 5 of initial chemotherapy were significantly higher in patients with than without anticipatory nausea. To determine whether elevated MHPG reflected a clinically significant causative role for noradrenergic activity in anticipatory nausea, we conducted a randomized, double-blind, placebo-controlled, crossover trial of clonidine for anticipatory nausea. At a dose of clonidine that produced significant side effects and reductions of plasma MHPG, anticipatory nausea was improved only marginally. These studies do not support a causative role for noradrenergic activity in anticipatory nausea that can be reduced by clonidine with an acceptable therapeutic index.

Administration, Oral↗