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PubMed2002

[Effects of dexamethasone on epidural morphine-related nausea and vomiting].

OBJECTIVE: To observe the effect of intravenous dexamethasone injections in preventing nausea and vomiting resulted from epidural morphine for post-operation pain relief. METHODS: Eighty-four adult patients (ASA class I to II ) requiring epidural anesthesia for low abdominal surgical procedures were randomly divided into 2 groups, of which Group 1 (n=42) received intravenous dexamethasone injections at 10 mg and Group 2 (n=42) intravenous injection of 2 ml normal saline before administration of 2 mg epidural morphine for post-operation pain relief. The incidence of nausea and vomiting were recorded within 24 h after surgery. RESULTS: The incidence of nausea and vomiting were 12% and 7% in Group 1, while 31% and 21% in Group 2 respectively, showing significant difference between the 2 groups (P<0.05). The total incidence of nausea and vomiting were also significantly different (19% vs 52%, P<0.01). CONCLUSION: Intravenous dexamethasone injections at 10 mg can significantly decrease the incidence of epidural morphine-related nausea and vomiting.

Adult↗
PubMed2003

Nausea and vomiting of pregnancy.

Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as ginger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxylamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition.

Acupressure↗
PubMed1957

Control of nausea and vomiting; observations on the use of chlortrimeton (chlorprophenpyridamine maleate) syrup.

Chlor-Trimeton (chlorprophenpyridamine maleate) syrup was effective in preventing and controlling nausea and vomiting in 53 of 57 patients. In doses of one to four teaspoonfuls (2 to 8 mg.), it controlled nausea and vomiting following operative procedures, vomiting due to nonspecific causes, hyperemesis gravidarum, vomiting in altitude and radiation sickness, and vomiting in patients with carcinoma of the colon, acute pancreatitis, and poorly controlled diabetes. No untoward effects from the drug were noted. The syrup was easy to administer, rapidly absorbed, and apparently provided a local anesthetic effect on gastric mucosa.

Anesthesia, Local↗
PubMed1992

Nausea and vomiting and cancer patients' quality of life: a discussion of Professor Selby's paper.

It is evident from the data presented above that nausea and vomiting are frequent side effects which are often persistent and distressing to patients. Evidence suggests, and intuitively it appears that avoidance of nausea and vomiting is important to the patients' ability to maintain their quality of life during the treatment period. It is of particular interest to note that in the literature reviewed in this paper standard antiemetic prescribing and practice were followed. It would, therefore, appear that available antiemetic agents are not always effective or may not be adequately employed. The toxicities associated with dopamine receptor antagonists, the current standard of antiemetic regimens, limit their usefulness in the clinical setting. In fact, the contribution of antiemetic therapy toxicities to the incidence of anxiety, fatigue, and restlessness which were commonly reported by patients in the studies reviewed should be considered. Additional effort to characterise the impact of nausea and vomiting on cancer patients' quality of life is needed. Clearly, the data available suggest that these symptoms should be included as part of the physical domain component of quality of life instruments used in cancer patients. Ideally, the instrument used should contain separate items for nausea and vomiting. Major side effects of antiemetic therapy should also be assessed since these may be as debilitating as the effects of nausea and vomiting. Increased awareness of total patient impact of emesis and antiemetic therapy will serve as an impetus for improvements in antiemetic therapy strategies and practices.

Antineoplastic Agents↗
PubMed2004

[Bilious vomiting due to malrotation, also in older children].

Three children presented with bilious vomiting due to malrotation at the age of 3, 5 and 12 years, respectively. They were treated surgically and recovered fully. In the period 1989-2002, 12 patients were operated for malrotation after the first year of life in the Emma Children's Hospital AMC, Amsterdam, the Netherlands. The mean age at operation was 5 years (range: 1-15). The most important symptoms were (bilious) vomiting and abdominal pain. Four patients had a history of bilious vomiting in the neonatal period. Nine patients had been previously admitted to a hospital with abdominal complaints. The most sensitive imaging technique was an upper gastrointestinal contrast study. Malrotation with intermittent volvulus can cause recurrent abdominal complaints and vomiting in children. Bilious vomiting is pathologic at any age and should lead to further investigations, preferably an upper gastrointestinal contrast study to exclude malrotation or other obstructions.

Adolescent↗
PubMed2004

[Tropisetron in attenuation of nausea and vomiting in patients undergoing high-dose chemo-radiotherapy supported by autologous peripheral blood stem cell transplantation].

BACKGROUND & OBJECTIVE: High-dose conditioning regimens of chemo-radiotherapy with or without total body irradiation (TBI) frequently induces nausea and vomiting in patients who are supported with stem cell transplantation. 5-Hydroxytrypamine(3) (5-HT(3)) receptor antagonists, when used alone, are unsatisfactory in the attenuation of emesis; Furthermore, consensus about their optimal dose, optimal dosing frequency and the combined use with other anti-emetic drugs are still controversial. The main objective of this trial was to observe the anti-emetic effectiveness and side effects of tropisetron plus dexamethasone and diphenhydramine (Group A) and tropisetron alone (Group B) on the patients undergoing high-dose treatment for peripheral blood stem cell (PBSC) mobilization and transplantation. METHODS: From December 1998 to September 2002, 68 patients undergoing autologous peripheral blood stem cell transplantation were allotted into this study. All the eligible patients were divided into group A or B non-randomly to compare the efficacy of the two regimens in the prevention of nausea and vomiting induced by high-dose treatment. Regimens:40 patients in group A were given tropisetron 5 mg,iv,every 12 h plus dexamethasone 5-10 mg, iv, daily, and diphenhydramine, 20 mg, im, daily. Twenty-eight patients in group B were received tropisetron alone,5 mg,iv,every 12h. RESULTS: For nausea during the acute phase, complete response rates of group A and B were 55% and 46.4%, with an overall response rates of 97.5% and 85.7%,of which the difference was insignificant (P >0.05). For vomiting during the acute phase, complete response rates of group A and B were 77.5% and 78.6%, with an overall response rates of 90% and 92.9%, of which the difference was insignificant (P >0.05). For delayed phase, both the complete response and overall response rates were higher in group A, with the difference significant (P< 0.05). The side effects of both regimens were mild. Common side effects including abdomen discomfort,headache,heavy head and constipation did not necessitate the discontinuity of high-dose treatment. CONCLUSION: The combination of tropisetron with dexamethasone and diphenhydramine is more effective than tropisetron alone in the control of nausea and vomiting induced by high-dose chemotherapy with or without TBI, which is especially more effective in the delayed phase of nausea and vomiting. The side effects of the combination regimen were mild. Based on these findings, we stress the importance of large randomized trials in the future.

Adolescent↗
PubMed2004

Use of dexamethasone to reduce postoperative vomiting and pain after pediatric tonsillectomy procedures.

OBJECTIVE: The purpose of this study is to determine whether a single dose of dexamethasone 0.5mg/kg administered before surgery could decrease post operative vomiting and pain and improves oral intake in the first 24-hours after pediatric tonsillectomy procedures. METHODS: It is a randomized, double blind, placebo controlled study. Sixty children age 2-12-years ASA 1 and 11 were scheduled for tonsillectomy, dexamethasone (n=29) and control group (n=31) were enrolled in the study. Dexamethasone group received 0.5mg/kg intravenous dexamethasone and control group received saline at the time of induction. The anesthetic regimen and surgical procedures were standardized for all patients. All patients were observed in post anesthesia care unit (PACU) and ward for post operative vomiting, pain, need for rescue antiemetic or analgesia and time for first oral intake for 24-hours. RESULTS: Data from 60 patients were analyzed. The overall incidence of early as well as late vomiting was significantly less in dexamethasone as compared to control group (37% versus 74% P=0.016), overall incidence of retching was 29% in control and 3.4% in dexamethasone (p=0.008). Vomiting once or more than once was significantly high in control as compared to dexamethasone group. The need for rescue antiemetic, the time to first oral intake and analgesic requirements did not show any significant difference in both groups. CONCLUSION: Dexamethasone is considered safe and there was no adverse effects associated with a single dose of dexamethasone. Although the need for rescue antiemetic, time to oral intake and analgesia requirements in both groups were not significant, however, we found that dexamethasone does have antiemetic properties as overall incidence of retching and vomiting was significantly less in dexamethasone group as compared to control group in children who underwent tonsillectomy.

Antiemetics↗
PubMed2005

[Preventive efficacies of china-made tropisetron hydrochloride and Navoban on chemotherapy-induced nausea and vomiting: a randomized controlled clinical trial].

BACKGROUND & OBJECTIVE: Navoban (import tropisetron hydrochloride) can effectively prevent chemotherapy-induced nausea and vomiting; however, it is too expensive to be used extensively in clinic. This study was designed to compare the antiemetic efficacies and side effects of China-made tropisetron hydrochloride with Navoban. METHODS: A multicenter and randomized controlled trial was carried out. A total of 132 cancer patients were randomized into 2 groups and received 5 mg of China-made tropisetron hydrochloride (group A, 66 patients) or Navoban (group B, 66 patients) intravenously before cisplatin- or adriamycin-based chemotherapy. The gastrointestinal reactions induced by chemotherapy and side effects of the antiemetics were recorded within 7 days after chemotherapy. RESULTS: Acute nausea was prevented completely in 48.5% of the patients in group A and in 43.8% of group B; acute vomiting was prevented completely in 69.7% of the patients in group A and in 67.2% of group B. Delayed nausea was prevented completely in 25.8% of the patients in group A and in 28.1% of group B; delayed vomiting was prevented completely in 47.0% of the patients in group A and in 51.6% of group B. No significant differences in complete control of nausea and vomiting showed between group A and group B (P > 0.05). Both antiemetic regimens were well tolerated, and no difference in adverse events between the 2 groups was observed (P > 0.05). CONCLUSION: China-made tropisetron hydrochloride is as effective as Navoban in the prevention of chemotherapy-induced nausea and vomiting, and only causes mild, infrequent side effects.

Adult↗
PubMed2005

[Effects of clonidine and midazolam on postoperative shivering, nausea, and vomiting].

BACKGROUND: Postoperative shivering, nausea, and vomiting are common problems after general anesthesia. We compared the effects of clonidine and those of midazolam on postoperative shivering, nausea and vomiting in elderly patients. METHODS: We studied 40 elderly patients (age > 60 yr) undergoing elective surgery under general anesthesia combined with epidural anesthesia. Patients were allocated randomly to receive oral clonidine 3-4 microg x kg(-1) (clonidine group) or intramuscular midazolam 0.04-0.05 mg x kg(-1) (midazolam group). Anesthesia was maintained with sevoflurane in a nitrous oxide and oxygen mixture, and fentanyl as needed, combined with epidural anesthesia with mepivacaine. Shivering, nausea, and vomiting were recorded at recovery from anesthesia, 3 h after the transference to the ward, and the next morning. Shivering was graded by using a three-point rating scale, whereas nausea and vomiting were assessed by means of a four-point rating. RESULTS: The incidence of shivering was lower at recovery from anesthesia in the clonidine group (P < 0.05). Likewise, the incidence of nausea was lower at recovery from anesthesia in the clonidine group (P < 0.05). There were no differences in shivering and nausea at other recording points. One patient in each group had vomiting. CONCLUSIONS: Clonidine premedication is effective for preventing shivering and nausea after general anesthesia combined with epidural anesthesia.

Administration, Oral↗
PubMed2005

[A patient care experience of the psychologically impaired cancer patient against chemotherapy--the successful outpatient case report using a sedative agent to reduce vomiting].

We would like to present a case report on how we managed to reduce an adverse effect of chemotherapy, specifically vomiting and nausea with a sedative agent diazepam, when a patient was intravenously injected with chemotherapeutic agents at the outpatient department. The patient was a 39-year-old female who experienced total hysterectomy and bilateral oophorectomy due to ovarian ca. (stage III) on May 29, 2002. She used to have complained of severe vomiting whenever undergoing 4-day inpatient chemotherapies every month from June 2002 to April 2003. In the last chemotherapy, she suffered vomiting prior to a day before the infusion and after 5 days of the infusion. Because of her experience, the patient refused to undergo the following chemotherapy. Based on discussions with her, use of sedatives was chosen to relieve vomiting. Due to relief of stress, the patient slept and relaxed by means of a sedative effect during and after administration of chemotherapy. Since the reduction of vomiting, she has been accepting further chemotherapies.

Adult↗
PubMed2006

[Clinical observation on electric stimulation of Yongquan (KI 1) for prevention of nausea and vomiting induced by Cisplatin].

OBJECTIVE: To search for an effective method for controlling nausea and vomiting induced by chemotherapy. METHODS: Eighty-eight cases of hepatic cancer with interventional therapy of Cisplatin were randomly divided into a treatment group and a control group, 44 cases in each group. The treatment group were treated with an antiemetic and electroacupuncture at Yongquan (KI 1), and the control group only with the antiementic. The controlling rates for nausea and vomiting were compared between the two groups. RESULTS: The controlling rates for acute nausea, vomiting and delayed vomiting in the treatment group were better than those in the control group (P < 0.05). CONCLUSION: Electroacupuncture at Yongquan (KI 1) can better prevent and improve the symptoms of nausea and vomiting in the patient with chemotherapy of Cisplatin.

Adolescent↗
PubMed2006

Effect of acupressure on nausea and vomiting induced by chemotherapy in cancer patients.

AIM: Corticosteroids, antidopaminergig agents and 5-HT3 antagonists are the most commonly used drugs in the treatment of chemotherapy-induced vomiting. Acupuncture and acupressure have also appeared to exert antiemetic effects. The aim of this study was to evaluate the efficacy of acupressure in the treatment of chemotherapy-induced vomiting resistant to the standard antiemetic therapies. METHODS: The study included 40 consecutive advanced cancer patients with untreatable chemotherapy-induced vomiting. Colorectal cancer, lung cancer and breast cancer were the neoplasm most frequent in our patients. According to tumour histotype, patients received chemotherapeutic regimens containing the main emetic cytotoxic agents, including cisplatin and athracyclines. Acupressure was made by PC6 point stimulation for at least 6 h/day at the onset of chemotherapy. RESULTS: The therapeutic approach was well accepted by the overall patients. An evident improvement in the emetic symptomatology was achieved in 28/40 (70%) patients, without significant differences in relation to neither tumor histotype, nor type of chemotherapeutic agent. CONCLUSIONS: This preliminary study seems to suggest that a bioenergetic approach by acupressure on PC6 point may be effective in the treatment of chemotherapy-induced vomiting resistant to the conventional pharmacological strategies, as previously demonstrated for vomiting occurring during pregnancy.

Acupressure↗
PubMed1991

Treatment of postoperative nausea and vomiting with ondansetron: a randomized, double-blind comparison with placebo.

Postoperative nausea and vomiting are common after recovery from general anesthesia. The antiemetic effect and safety of ondansetron, a selective serotonin type 3 (5-HT3) receptor antagonist, was determined in 36 patients suffering from nausea or vomiting during recovery from intravenous anesthesia by giving either a single intravenous dose of ondansetron (8 mg, n = 18) or placebo (n = 18) over 2-5 min in a randomized, double-blind manner. A "rescue" antiemetic was provided in case of continued vomiting or at the patient's request. Antiemetic efficacy was defined as no request for rescue antiemetic and/or no vomiting episode during the next 4 h. There was no significant difference in the demographic data between the groups. Administration of ondansetron or placebo had no significant effect on vital signs. Ondansetron was an effective antiemetic in 78% (14/18) and placebo was effective in 28% (5/18) of the patients. Laboratory studies 24 h later showed no signs of hematologic, hepatic, or renal alterations. Ondansetron at a dose of 8 mg administered intravenously over 2-5 min appears to be a safe and effective antiemetic for the treatment of nausea and/or vomiting after intravenous anesthesia.

Adolescent↗
PubMed1991

Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.

Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy. Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 +/- 0.8), as did ten of 28 patients in the placebo group (mean 8.7 +/- 0.9) (not significant). Following therapy, there was a significant difference in the mean "difference in nausea" score (ie, baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Patterns of nausea and vomiting in children: nursing assessment and intervention.

Although aggressive treatments for childhood cancer have resulted in an increased cure rate, increased incidence of treatment-related side effects also has occurred. Nausea and vomiting are two common side effects of cancer treatment in children. This clinical review discusses nursing issues related to the treatment of nausea and vomiting in children. Focus is placed on assessment, incidence and etiology of nausea and vomiting, patterns of nausea and vomiting, developmental influences on nursing intervention, innovative nursing strategies, behavioral interventions, specific antiemetic therapy, and home care. A need for further study of nausea and vomiting associated with childhood cancer treatment is identified.

Adolescent↗
PubMed1990

[Evaluation of antiemetic effect of clonazepam, metoclopramide, dexamethasone and diphenhydramine for prevention of cisplatin-induced vomiting].

In prospective alternative crossover test, we confirmed significant superiority of a three-drug combination of clonazepam (C) lorazepam (L) and dexamethasone (D) to (L) and (D) to control vomiting induced by 50 mg/m CDDP containing chemotherapy for gynecological malignancies (p less than 0.001). Vomiting frequency in initial 24 hours was 2.28 +/- 2.21 and 6.00 +/- 3.80 times a day respectively. According to this result, clonazepam, dexamethasone, metoclopramide and diphenhydramine (B) were used as a second regimen to control the vomiting in 80 mg/m CDDP containing chemotherapy for ovarian cancer patients. Clonazepam (2 mg 2 times p.o. -4 and 0 hrs before CDDP drip), dexamethasone (8 mg 5 times iv from -3 hrs each 3 hrs), metoclopramide (2.5 mg/kg iv loading from -2 hrs with 0.4 mg/kg/hr continuous infusion for 9 hrs) and diphenhydramine (30 mg/body 2 times im -2.6 hrs) were chosen to control CDDP-induced nausea and vomiting. These four drugs (C+L+D+B) prominently inhibited the chemo-induced vomiting up to 0.44 +/- 1.50 times a day, and 87.5% of courses was completely satisfactory.

Adult↗
PubMed1989

[Amelioration of cisplatin-induced vomiting and anorexia by methylprednisolone].

Amelioration of cisplatin (CDDP)-induced vomiting and anorexia by methylprednisolone (MP) was studied using conscious dogs. The incidence of vomiting was 88.9% and the mean number of emetic episodes was 8.22 +/- 1.25/dog during 5 hours after i.v. administration of 1.5 mg/kg CDDP in 9 dogs. In control dogs, food intake on the day after administration of CDDP was markedly reduced to 60 +/- 22.4 g/day from 461 +/- 23 g. Continuous high-dose infusion of MP (10 mg/kg, 10 min before the start of CDDP infusion and 50 mg/kg/h for 5 h) markedly reduced the incidence (33%) and mean number of vomiting episodes (2.00 +/- 1.51/dog) and also mitigated the reduction of food intake (350 +/- 30.6 g/day). However, continuous low-dose infusion of MP (5 mg/kg, 10 min before CDDP infusion and 16.6 mg/kg/h for 5 h) showed a little effect on CDDP-induced vomiting. Plasma MP levels after the high-dose and the low-dose regimens were 6.20 +/- 0.628 micrograms/ml and 4.66 +/- 1.72 micrograms/ml, respectively, 30 min after CDDP infusion. In both cases, MP levels gradually increased and reached to those more than twice 5 hours after CDDP infusion. Bolus administrations of MP (30 mg/kg, each time) 2 hr and 30 min before CDDP infusion also significantly reduced the mean number of emetic episodes (3.22 +/- 1.33/dog) and mitigated the reduction of food intake (325 +/- 37.3 g/day). No significant changes in catecholamines, prostaglandins, vasopressin, plasma renin activity, Na+, K+, Mg++ and osmolality in peripheral blood were noted after administration of CDDP and/or MP. The results suggest that administration of MP was effective against CDDP-induced vomiting and anorexia in dogs.

Animals↗
PubMed1987

Possible role of brain stem respiratory neurons in mediating vomiting during space motion sickness.

Vomiting is produced primarily by the coordinated action of the respiratory muscles. The object of this study was to determine if brain stem expiratory neurons control abdominal muscle activity during vomiting. We recorded the activity of 27 ventral respiratory group (VRG) expiratory neurons, which are known to be of primary importance for control of abdominal muscle activity during respiration. During fictive vomiting produced by emetic stimulants in decerebrate, paralyzed cats, only one-third of these neurons had the appropriate firing pattern to contribute to abdominal muscle activity during vomiting. In a second series of experiments, we recorded abdominal muscle activity in five cats before and after cutting the axons of VRG expiratory neurons. Abdominal activity remained at 60-100% of prelesion values in three animals. Thus, abdominal muscle activity during vomiting must be controlled not only by some brain stem expiratory neurons but also by other input(s).

Abdominal Muscles↗