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PubMed1992

Total intravenous anaesthesia with propofol and alfentanil protects against postoperative nausea and vomiting.

The incidence of postoperative nausea and vomiting and requirements for anti-emetic medication were assessed in 80 female patients undergoing day-case anaesthesia during assisted conception therapy. Anaesthesia was induced with alfentanil 50 micrograms.kg-1 and propofol 1 mg.kg-1; atracurium 0.5 mg.kg-1 was given to facilitate tracheal intubation. The patients were allocated to receive either total intravenous maintenance of anaesthesia with an infusion of propofol and increments of alfentanil (Group P) or inhalational maintenance of anaesthesia with nitrous oxide and enflurane (Group E). Postoperative nausea, retching, vomiting, requirements for anti-emetic therapy, and unplanned admission for overnight stay in hospital were recorded. Overall incidence of nausea was 64% in group E and 39% in Group P (P less than 0.05). Incidence of vomiting was 67% in Group E and 34% in Group P (P less than 0.05). Metoclopramide was requested by 62% of patients in Group E, and 32% of those in Group P (P less than 0.05); 21% of the patients in Group E were admitted to hospital overnight, while only 5% of the patients in Group P required unscheduled admission to hospital (P less than 0.05). We conclude that total intravenous anaesthesia with propofol and alfentanil is superior to inhalational maintenance with nitrous oxide and enflurane in that it is associated with less nausea and vomiting, less requirement for anti-emetic medication, and a lower probability of unplanned admission to hospital after day-care gynaecological surgery.

Adult↗
PubMed1994

Reduction of postoperative nausea and vomiting with granisetron.

The antiemetic effects of granisetron, a selective 5-hydroxy-tryptamine type 3 receptor antagonist, on postoperative nausea and vomiting were studied and compared with placebo and metoclopramide in 60 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single i.v. dose of either granisetron (3 mg, n = 20) metoclopramide (10 mg, n = 20), or placebo (saline, n = 20) immediately after recovery from anaesthesia. The effects were assessed during the first three and the next 21 hr after recovery from anaesthesia by means of a nausea and vomiting score; 0 = no emetic symptoms, 1 = nausea, 2 = vomiting. The mean scores during 0-3 hr were 0.8, 0.1 and 0.1 after administration of placebo, metoclopramide and granisetron, respectively; the corresponding scores during 3-24 hr were 0.6, 0.5 and 0.1. The scores of the metoclopramide and the granisetron groups were different from the placebo group in the first three hours (P < 0.05). Although there were no differences in the scores during 0-3 hr between the metoclopramide and the granisetron groups, there were differences during 3-24 hr (P < 0.05). It is concluded that granisetron is superior to metoclopramide in the long-term prevention of postoperative nausea and vomiting after anaesthesia.

Adult↗
PubMed1995

Prevention of postoperative nausea and vomiting with granisetron: a randomized, double-blind comparison with droperidol.

The effects of granisetron for preventing postoperative nausea and vomiting were investigated in a randomized, double-blind comparison with droperidol and placebo in 100 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single dose of either granisetron (40 micrograms x kg(-1), n = 25), droperidol (1.25 mg, n = 25; 2.5 mg n = 25) or placebo (saline, n = 25)iv over two to five minutes immediately before induction of anaesthesia. The antiemetic effects of these drugs were evaluated during the first three and the next 21 hr after recovery from anaesthesia. During 0-3 hr after anaesthesia, the frequency of nausea and vomiting was 60%, 12%, 16% and 12% after administration of placebo, granisetron, droperiodol 1.25 mg or droperidol 2.5 mg, respectively. The corresponding frequencies during 3-24 hr after anaesthesia were 44%, 8%, 36% and 12%. The efficacy of granisetron in preventing postoperative nausea and vomiting was almost equal to that of droperidol 2.5 mg. The awakening time in the patients who had received droperidol 2.5 was prolonged by approximately three minutes compared with the placebo group (P <0.05), and postoperative drowsiness/sedation was observed in these patients. In conclusion, preoperative prophylactic administration of granisetron is superior to that of droperidol in the prevention of postoperative nausea and vomiting after anaesthesia.

Adult↗
PubMed1996

Antiemetic effects of granisetron on postoperative nausea and vomiting in patients with and without motion sickness.

PURPOSE: This randomized, placebo-controlled, double-blind study was to evaluate the effects of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for preventing postoperative nausea and vomiting in 110 patients with (n = 50) and without (n = 60) a history of motion sickness undergoing general anaesthesia for major gynaecological surgery. METHODS: The patients received a single dose of either granisetron (40 micrograms.kg-1) or placebo (saline) iv over 2-5 min immediately before induction of anaesthesia. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of nausea and vomiting were recorded. RESULTS: Except for a positive history of motion sickness, the treatment groups were similar for patient characteristics, types of surgery, anaesthetics administered and opioids given. Postoperatively, the frequency of nausea was 44% and 16% after administration of placebo and granisetron in patients with motion sickness, and was 30% and 7% in patients without it, respectively; the corresponding frequencies of vomiting were 28%, 8%, 13% and 3%. The incidence of adverse events postoperatively were not different among the groups. CONCLUSION: These results suggest that preoperative prophylactic administration of granisetron is effective and safe for preventing postoperative nausea and vomiting in patients with motion sickness as well as in patients without it.

Adult↗
PubMed1996

Reduction of post-operative nausea and vomiting with the combination of morphine and droperidol in patient-controlled analgesia.

PURPOSE: To determine whether low doses of droperidol mixed with morphine in patient-controlled analgesia (PCA) would extend the duration of prophylaxis against postoperative nausea and vomiting. METHODS: Healthy women having elective open-abdominal gynaecological surgery consented to this double-blind, placebo-controlled study. Subjects were randomized to receive placebo, or 1 mg droperidol before induction followed by droperidol 0.0 (bolus group), 0.02 (0.02 group), or 0.04 (0.04 group) mg.mg-1 of PCA morphine. Study endpoints included severity of nausea, episodes of vomiting and rescue antiemetic doses, pain, and sedation and were assessed at 1, 2, 4, 8, 12, 16, 20 and 24 hr postoperatively. RESULTS: Seventy-one subjects completed the study. The groups were similar in age, weight, surgical time, pain scores, and morphine used. The 0.04 group had lower mean visual analogue scale scores for nausea (P < 0.05 vs all other groups). The incidence of vomiting was lower in all treatment groups (P < 0.05 for all groups vs placebo). The 0.04 group had lower rescue antiemetic requirements than the bolus group (P < 0.03). Mean sedation scores were low in all groups but were increased with PCA droperidol (P < 0.02). CONCLUSIONS: Droperidol 1 mg before induction of anaesthesia reduces postoperative vomiting. The addition of droperidol 0.04 mg.mg-1 of PCA morphine further reduces (i) severity of nausea and (ii) rescue antiemetic requirements postoperatively. No clinically significant side-effects were attributed to this regimen.

Adolescent↗
PubMed1994

Adjuvant propofol enables better control of nausea and emesis secondary to chemotherapy for breast cancer.

We investigated the prophylactic antiemetic effect of added low-dose infusion of propofol in patients exhibiting nausea and vomiting refractory to dexamethasone and serotonin antagonist during non-cisplatin chemotherapy for breast cancer. In a prospective open longitudinal study, 117 patients who had more than five episodes of nausea and vomiting in their first chemotherapy cycle during the first 24 hr completed the study. They received in addition to the usual prophylactic antiemetic regimen a continuous intravenous infusion of 1 mg.kg-1.hr-1 propofol started four hours before chemotherapy and continued up to 24 hr for the two subsequent cycles. The number of vomiting/nausea episodes, level of sedation, patient activity, appetite and preference for future chemotherapy cycles were assessed. In the propofol supplemented cycles 90 and 80% of patients, during the 1st and 2nd propofol-assisted cycle respectively, were free of nausea and vomiting during the first 24 hr after chemotherapy. Patients were more frequently active and had more appetite during the propofol-assisted cycles. No propofol-associated side effects were observed. We conclude that the addition of a subhypnotic infusion of propofol enables better control of nausea and vomiting caused by non-cisplatin chemotherapy in the first 24 hr post-treatment.

Aged↗
PubMed2000

Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting.

PURPOSE: To estimate the efficacy and harm produced by droperidol in the prevention of postoperative nausea and vomiting (PONV). METHODS: Systematic search (MEDLINE, EMBASE, Cochrane library, hand-searching, bibliographies, all languages, up to May 1999) for randomised comparisons of droperidol with placebo in surgical patients. Relevant end points were prevention of early PONV (up to six hours postoperatively), and late PONV (24 hr), and adverse effects. Combined data were analysed using relative risk and NNT. RESULTS: In 76 trials, 5,351 patients received 24 different regimens of droperidol. The average incidence of early and late PONV in controls was 34% and 51%, respectively. Droperidol was more efficacious than placebo in preventing PONV. In adults, the anti-nausea effect was short-lived, and there was no dose-responsiveness; with 0.25 to 0.30 mg the number-needed-to-treat (NNT) to prevent early nausea was 5. For both early and late anti-vomiting efficacy there was dose-responsiveness; best efficacy was with 1.5 mg to 2.5 mg (NNT, 7). In children, there was dose-responsiveness; best efficacy was with 75 microg x kg(-1) (NNT to prevent early and late vomiting, 4). Two children had extrapyramidal symptoms with droperidol (NNT in children, 91; in any patient, 408). There was dose-responsiveness for sedation and drowsiness (with 2.5 mg the NNT was 7.8). Droperidol prevented postoperative headache (NNT, -25). CONCLUSIONS: Droperidol is anti-emetic in the surgical setting. The effect on nausea is short-lived but more pronounced than the effect on vomiting. Sedation and drowsiness are dose-dependent, extrapyramidal symptoms are rare, and there is a protective effect against headache.

Adult↗
PubMed2005

[A factorial trial of six interventions for the prevention of postoperative nausea and vomiting].

BACKGROUND: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. METHODS: In a randomized, controlled trial of factorial design, 5,199 patients at high risk for postoperative nausea and vomiting were randomly assigned to 1 of 64 possible combinations of 6 prophylactic interventions: 1) 4 mg of ondansetron or no ondansetron; 2) 4 mg of dexamethasone or no dexamethasone; 3) 1.25 mg of droperidol or no droperidol; 4) propofol or a volatile anesthetic; 5) nitrogen or nitrous oxide; 6) remifentanil or fentanyl. The primary aim parameter was nausea and vomiting within 24 h after surgery, which was evaluated blindly. RESULTS: Ondansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26%, propofol reduced the risk by 19%, and nitrogen by 12%. The risk reduction with both of these agents (i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics alone. All the interventions acted independently of each other and independently of the patients' baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. However, absolute risk reduction was a critical function of patients' baseline risk. CONCLUSIONS: Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.

Analgesics, Opioid↗
PubMed1996

[Transdermal scopolamine for prevention of postoperative nausea and vomiting. No clinically relevant result in spite of reduced postoperative vomiting in general surgical and gynecologic patients].

UNLABELLED: In a prospective double-blind trial, transdermal scopolamine (TS) was compared to placebo (P) in the prevention of postoperative nausea and vomiting (PONV) within a 48-h interval. After stratification for gender and surgical procedure, patients were randomly chosen to receive either TS or placebo. METHODS: Of 304 surgical and gynaecological patients included in this study, the data of 263 patients were evaluated (48 thyroidectomies, 15 open, and 36 laparoscopic cholecystectomies, 41 open, and 36 laparoscopic hernia repairs, 37 hysterectomies, and 50 gynaecological laparoscopies). The two groups were comparable with regard to biometrical data and duration of anaesthesia and surgery. Although anaesthesia was not standardized, there was no difference in anaesthesia techniques, drug dosage or perioperative management. Patients were evaluated once preoperatively and 2, 6, 10, 24, and 48 h postoperatively using a 100-mm visual analogue scale (VAS) for "nausea", "pain", "dry mouth", "sedation", and "blurred vision". Episodes of vomiting or retching and the need for additional antimetics (0.03 mg.kg-1 metoclopramide i.v., followed by 1 mg.kg-1 dimenhydrinat i.v., if necessary) were recorded. RESULTS: TS significantly reduced the incidence of postoperative vomiting within the first 48 h postoperatively [TS: 47 patients (36.2%) with 125 cumulative episodes vs P: 70 patients (52.6%) with 209 cumulative episodes]. Analysing the five observation intervals seperately, this difference could only be demonstrated 0-2 h and 6-10 h postoperatively. In patients suffering from emetic sequelae, TS did not reduce the frequency of vomiting significantly (mean frequency: TS: 2.7 vs P: 3.0). TS also had no significant effect on the requirement of additional antiemetics [TS:. 81 times in 46 (35.7%) patients vs P: 116 times in 58 (44.3%) patients]. Nausea as rated by the VAS was not significantly different between the two groups at any time during the postoperative observation. No relevant side-effects occurred, although there was a trend toward higher ratings of "dry mouth" in the TS group, reaching statistical significance 10 h after operation. CONCLUSION: The routine administration of TS for gynaecological and surgical patients cannot be recommended because of the lack of effect on postoperative nausea and only marginal benefit concerning postoperative vomiting.

Administration, Cutaneous↗
PubMed2001

Ondansetron in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: There is an increased incidence of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. The aim of the study was to evaluate the efficacy of intravenous ondansetron, a 5-HT anatagonist, for prevention from PONV after laparoscopic cholecystectomy. METHODS: Sixty-eight patients were entered into the study. Thirty-six patients were randomized to receive a single intravenous dose of 4 mg of ondansetron before extubation. Thirty-two patients received no prophylaxis. There were no differences in terms of sex ratio, age, ASA status, and duration of operation between the two study groups. Patients were interviewed by an independent observer to assess the postoperative pain and nausea using visual analog score. Patients' satisfaction scores to the procedure were measured. RESULTS: There was no complication in the series. Pain scores at 2 and 24 h after operation and analgesics consumption were not different between the two groups. For the patients who received ondansetron, the mean (SD) nausea score at 2 and 24 h was 1.5 (1.2) and 1.4 (1.4), respectively. The score for the control group was 1.4 (1.0) and 1.2 (0.5), respectively. There was also no difference in episodes of vomiting and usage of antiemetics between the two groups. Both groups were equally satisfied with the procedures. CONCLUSION: Routine use of ondansetron does not reduce the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy.

Adult↗
PubMed2002

A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients.

Nausea and emesis are common side effects of opioid drugs administered for pain relief in cancer patients. The aim of this study was to compare the anti-emetic efficacy and safety of ondansetron, placebo and metoclopramide in the treatment of opioid-induced nausea and emesis (OIE) in cancer patients. This was a multinational, multicentre, double-blind, parallel group study in which cancer patients who were receiving a full opioid agonist for cancer pain were randomised to receive one of oral ondansetron 24 mg once daily, metoclopramide 10 mg three times daily, or placebo. Study medication was started only if the patient experienced nausea and/or emesis following opioid administration. Efficacy and safety assessments were made over a study period of 24 h from the time of the first dose of anti-emetics/placebo. The study was terminated prematurely because of the difficulties in recruiting patients satisfying the stringent entry criteria. Ninety-two patients were included in the intent-to-treat population: 30 patients received placebo, 29 patients ondansetron and 33 patients metoclopramide. There was no statistically significant difference between the groups in the proportion achieving complete control of emesis (33% of patients on placebo, 48% on ondansetron and 52% on metoclopramide) or complete control of nausea (23% of patients on placebo, 17% on ondansetron and 36% on metoclopramide). Rescue anti-emetics were required in 8 of 33 patients on metoclopramide, 4 of 29 on ondansetron, and 3 of 30 on placebo. The incidence of adverse events was very low and similar in all treatment groups. Neither ondansetron 24 mg once daily nor metoclopromide 10 mg t.d.s. given orally was significantly more effective than placebo in the control of OIE in cancer patients.

Adult↗
PubMed2003

Assessing the impact of chemotherapy-induced nausea and vomiting on patients' daily lives: a modified version of the Functional Living Index-Emesis (FLIE) with 5-day recall.

BACKGROUND: The Functional Living Index-Emesis (FLIE), a patient-reported outcome measure, was originally developed to assess the impact of chemotherapy-induced nausea and vomiting (CINV) on patients' daily lives over the 3 days following chemotherapy. More recent studies of CINV include assessments covering the 5 days following chemotherapy in an effort to capture information during both the acute (within 24 h) and delayed (up to 5-7 days) phases of CINV. GOALS: To assess the measurement characteristics of a modified version of the FLIE with 5-day recall. Instrument reliability, validity, and missing data were assessed. PATIENTS AND METHODS: Data were collected from 183 patients receiving cisplatin >or=70 mg/m(2) as part of a phase IIb antiemetic trial of an NK-1 receptor antagonist (MK-0869). Patients recorded the number of vomiting episodes and nausea ratings in a 5-day daily diary. RESULTS: The 5-day FLIE had: (1) excellent internal consistency within FLIE Nausea and Vomiting domains (Cronbach's alpha 0.77-0.78), (2) acceptable construct validity shown by FLIE item-total correlations stronger within domains ( r=0.74-0.97) than across domains ( r=0.52-0.76), and (3) acceptable convergent validity as shown by moderate to strong correlations between FLIE domain scores and independent endpoints of emetic episodes, nausea ratings, and use of rescue medications. The extent of missing data was within acceptable limits with less than 2% of patients missing data. CONCLUSION: The 5-day FLIE had adequate measurement characteristics for studying the impact of CINV on patients' daily lives during the period covering both the acute and delayed phases.

Activities of Daily Living↗
PubMed2000

Treatment of nausea and vomiting in advanced cancer.

Nausea and vomiting unrelated to chemotherapy is common in advanced cancer patients. The etiology of nausea and vomiting may from evident by the pattern of vomiting, associated symptoms, review of medications and physical examination. Radiographic studies are particularly helpful if bowel obstruction is suspected or central nervous system metastases are a possibility. Laboratory studies are helpful in a minority of cases. Multiple classes of medications are available to palliate nausea and vomiting. Classes of agents are discussed, pharmacology and cost being among the aspects covered. A four-step approach to the medical management of nausea and vomiting is presented.

Antiemetics↗
PubMed1999

A multicenter, double-blind, randomized comparison of oral ondansetron 8 mg b.i.d., 24 mg q.d., and 32 mg q.d. in the prevention of nausea and vomiting associated with highly emetogenic chemotherapy. S3AA3012 Study Group.

The objectives of this study were to compare the efficacy and safety of orally administered ondansetron 8 mg b.i.d., 24 mg q.d., and 32 mg q.d. in the prevention of nausea and vomiting associated with high-dose cisplatin-based chemotherapy (cisplatin > or = 50 mg/m2). This was a randomized, parallel-group, double-blind study conducted in North America. It was planned that all patients would receive one of the following orally administered ondansetron treatments 30 min before starting cisplatin dosing (administered over < or = 3 h): 8 mg b.i.d. with 8 h between doses (124 patients), 24 mg q.d. (116 patients), and 32 mg q.d. (117 patients). Use of prophylactic corticosteroids was not permitted. During the 24-h study period, the highest complete response rate (no emesis, rescue antiemetic therapy, or withdrawal) occurred in patients who received ondansetron 24 mg q.d.: 76/115 or 66%, as against 68/124 (55%) after ondansetron 8 mg b.i.d. and 64/117 (55%) after ondansetron 32 mg q.d. Complete control of nausea (no nausea, no rescue, no withdrawal) occurred in more patients in the ondansetron 24 mg q.d. group (64/114, 56%) than in the ondansetron 8 mg b.i.d. group (43/121, 36%) or in the ondansetron 32 mg group (55/117, 50%). These results demonstrate that following highly emetogenic cisplatin-based chemotherapy (> or =2 50 mg/m2), oral ondansetron 24 mg q.d. is more effective than 8 mg b.i.d. for overall control of nausea, and at least as effective if not more effective in the control of acute vomiting than 8 mg b.i.d. or 32 mg q.d. Ondansetron 24 mg q.d. was well tolerated, and no new or unexpected adverse events were identified.

Administration, Oral↗
PubMed2002

Use of transcutaneous nerve stimulation wristband to treat methotrexate-induced nausea.

BACKGROUND: Although methotrexate is a highly effective treatment for psoriasis, nausea and vomiting may be dose-limiting side effects. Various approaches have been used to improve the tolerability of methotrexate therapy, including changing the dose or form of administration of the methotrexate or concomitant administration of folic acid or an antiemetic. OBJECTIVE: The objective of this case report is to present the use of a novel, nonpharmacologic approach for controlling the nausea associated with methotrexate therapy. RESULTS: A 47-year-old patient with long-standing psoriasis was treated with methotrexate. She developed nausea refractory to standard antiemetic measures. She noted almost immediate relief of her nausea when using a transcutaneous nerve stimulation wristband. CONCLUSIONS: Nerve stimulation may be a valid alternative to other first-line antiemetic therapies.

Female↗
PubMed1995

Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Our purpose was to determine the effectiveness of pyridoxine for nausea and vomiting of pregnancy. STUDY DESIGN: During an 11-month period 342 women who first attended Chiang Mai University Hospital antenatal clinic at < or = 17 weeks' gestation were randomized to received either oral pyridoxine hydrochloride, 30 mg per day, or placebo in a double-blind fashion. Patients graded the severity of their nausea by a visual analog scale and recorded the number of vomiting episodes over the previous 24 hours before treatment and again during 5 consecutive days on treatment. RESULTS: There was a significant decrease in the mean of posttherapy minus baseline nausea scores in the pyridoxine compared with that in the placebo group (t test, p = 0.0008). There was also a greater reduction in the mean number of vomiting episodes, but the differences did not reach statistical significance (p = 0.0552). CONCLUSION: Pyridoxine is effective in relieving the severity of nausea in early pregnancy.

Adult↗
PubMed1985

Successful administration of metoclopramide for the treatment of nausea in patients with advanced liver disease. A double-blind controlled trial.

A double-blind comparison of metoclopramide versus placebo was performed on 8 cirrhotic patients with nausea (8 cases) and heartburn (3 of the 8 cases) plus mild portal-systemic encephalopathy. As metoclopramide is a dopamine antagonist and dopamine-inadequate neurotransmission has been implicated in the pathogenesis of hepatic coma, this study was also designed to evaluate the effects of metoclopramide on mental state. The study included basal, placebo, metoclopramide, and final periods; each period lasted for 2 wk. Throughout the study patients received 3 g/day of neomycin and an 1800-cal diet containing 40 g/day of mixed protein. During the placebo and metoclopramide phases patients received either two 10-mg metoclopramide capsules t.i.d. or identical placebo capsules. During the study, biweekly liver function tests and portal-systemic encephalopathy parameters were evaluated. A self-evaluation for the presence of nausea and heartburn was also obtained. To monitor the dopamine-blockade effect of metoclopramide, serum prolactin levels were measured. Metoclopramide significantly suppressed the subjective signs of nausea (7 of 8 cases) and heartburn (all cases). Serum prolactin levels were 22 +/- 21 ng/ml, 30 +/- 31 ng/ml, 110 +/- 57 ng/ml (p less than 0.01), and 18.6 +/- 2 ng/ml during basal, placebo, metoclopramide, and final periods, respectively. In spite of these signs of dopamine blockade, no deterioration in mental state, asterixis, electroencephalograms, blood ammonia levels, or psychometric testings were observed. In addition, no extrapyramidal signs were noticeable during any period of the study. One patient presented transient somnolence at the end of the metoclopramide period. We conclude that dopamine blockade is not associated with the appearance of portal-systemic encephalopathy. Metoclopramide is a safe and effective treatment for nausea and heartburn in patients with advanced liver disease.

Chronic Disease↗
PubMed1995

Fat increases vection-induced nausea independent of changes in gastric emptying.

Vection and fat delay gastric emptying and can induce nausea. Therefore, we studied the interaction between vection and fat on the production of nausea and the relationship between the severity of symptoms and changes in gastric emptying. Twelve healthy males consumed two liquid test meals, a zero-fat and a high-fat meal. Nausea was induced by seating the subjects inside a rotating vection drum. In protocol 1, drum rotation started immediately after ingestion of either meal; in protocol 2, when approximately 50% of each meal had emptied into the intestine. Gastric emptying was determined using gamma scintigraphy. Severity of symptoms was assessed throughout. Symptoms were similar for the high-fat and the zero-fat meal when vection was induced immediately after meal ingestion. Scores were only elevated by the high-fat meal when about half the meal had entered the intestine before vection was induced. No correlation was found between gastric emptying and the severity of symptoms. In conclusion, the interaction of vection and intraduodenal fat exacerbates nausea, but this effect is independent of a delay in gastric emptying.

Adult↗