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PubMed2005

Tropisetron: optimal dosage for children in prevention of chemotherapy-induced vomiting.

The antiemetic efficacy and tolerability of Tropisetron (Navoban, Novartis Pharma Switzerland AG, Bern), a selective 5-hydroxytriptamine receptor antagonist, has been assessed in the prevention of acute vomiting in children receiving chemotherapy for solid tumors. Tropisetron iv was given 30 min before administration of chemotherapy at a dose of 5 mg in children <20 kg body weight and at a dose of 10 mg in those >20 kg. A total of 50 children were studied in 189 courses of chemotherapy. Control of emesis was defined as total in absence of acute vomiting, as major if 1 or 2 events of acute vomiting occurred, and as not controlled if >2 events of acute vomiting occurred. Response was studied, taking into account Tropisetron dosage, degree of emetogenicity of the chemotherapeutic agents in pretreated and non-pretreated patients, and according to age groups. Tropisetron, administered in a single daily dose of 8-12 mg/m(2), was found to be very effective in completely controlling acute emesis in 92% of the courses of moderately and highly emetogenic chemotherapy administered to pediatric patients with solid tumors. Moreover, Tropisetron, at this dosage, did not lead to any adverse effects.

Adolescent↗
PubMed1986

An effective five-drug antiemetic combination for prevention of chemotherapy-related nausea and vomiting. Experience in eighty-four patients.

Antiemetics of known efficacy have been shown to block mainly one of three neurotransmitter receptors in the brain. A combination of antiemetics, designed specifically for outpatient use and consisting of metoclopramide, thiethylperazine, diphenhydramine, dexamethasone, and diazepam, is capable of blocking multiple sites in the emesis pathway. Eighty-four patients receiving highly emetic chemotherapy (85% received cisplatin) completed 200 trials of this five-drug combination using two similar regimens. Complete control (i.e., no nausea or vomiting) was achieved in 45% and two or fewer episodes of vomiting was experienced in 72% of these 200 trials. The mean number of vomiting episodes was 1.65, the median 1.0, and the range 0-15. Sedation was nearly universal, although no serious toxicity was encountered. Thus, this antiemetic combination designed for outpatient use proved highly effective in controlling nausea and vomiting associated with highly emetic anticancer treatment.

Adolescent↗
PubMed1982

A cognitive-behavioral model for the treatment of chronic vomiting.

The treatment approaches for chronic vomiting have primarily utilized behavior conditioning models and have largely focused on hospitalized infants, retarded patients, or trauma patients. A substantial number of patients who exhibit the symptoms of vomiting could be diagnosed as neurotic vomiters or "bulimics," and there is a dearth of information on the treatment of these patients. This paper presents a case study of a 26-year-old woman diagnosed as suffering from bulimia of 10 years' duration. The treatment program involved three basic components: self-monitoring, stimulus control, and cognitive restructuring. The treatment components were instituted sequentially. The treatment program was successful, and a 1-year follow-up found that the patient has maintained her progress and not vomited in over 5 months. The discussion focuses on the advantages of this treatment model in dealing with bulimia, which is conceptualized as a habit-type behavior disorder.

Adult↗
PubMed1991

Idiopathic gastroparesis in patients with unexplained nausea and vomiting.

Nausea and vomiting are symptoms sometimes associated with motor dysfunction. We compared a group of young patients suffering from chronic nausea and/or vomiting and normal upper gastrointestinal x-ray series with a control group. The members of both groups underwent isotopic examinations of their stomachs. The aim of the study was to find a simple method of checking the stomach and proving a motor dysfunction in a group of patients with chronic, inexplicable nausea and vomiting. Patients and controls fasted for at least 6 hr were given 0.5 mCI of [99mTc] diethylene triaminopentaacetic acid orally in 150 cc milk with 50 g cornflakes. A time-activity curve was obtained and radioactivity over the stomach was recorded exponentially. The parameter of the T1/2 emptying time was used. In normal controls T1/2 emptying time ranged from 18 to 26 min. Twenty-five symptomatic patients were examined, three of whom achieved normal values, but 22 patients showed pathologic results ranging from 36 to 184 min. In patients with chronic nausea and/or vomiting an isotopic examination of the stomach may provide a simple and rapid diagnostic method of evaluation.

Adult↗
PubMed1981

Effect of low dose droperidol on postoperative vomiting in children.

This double-blind study assessed the effect of low dose droperidol (0.005 mg x kg-1) on the incidence of postoperative vomiting in 200 children in ASA classification I and II, ranging from one to 15 years of age. The results showed that the dose of droperidol used in this study was very effective in reducing vomiting in children 11 to 15 years of age. The duration of stay in the post-anaesthetic care unit was not prolonged and no extrapyramidal symptoms related to the drug were observed. In our opinion the administration of droperidol 0.005 mg x kg-1 before the end of the operation will reduce the possibility of vomiting within 24 hours of operation in children in 11-15 year age group who are expected to have a high incidence of postoperative vomiting.

Adolescent↗
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↗
PubMed1988

Postoperative vomiting following strabismus surgery in paediatric outpatients: spontaneous versus controlled ventilation.

The study was designed to compare the frequency and severity of postoperative vomiting in paediatric out-patients receiving controlled ventilation (IPPV) or breathing spontaneously (SV) during anaesthesia for strabismus repair. One hundred and twenty unpremedicated children (ages 2-12 years) were studied in a randomized fashion. After intravenous induction of anaesthesia and tracheal intubation, patients breathed halothane 1-1.5 per cent inspired and N2O 66 per cent in O2 spontaneously (n = 60), or received IPPV, halothane 0.5-1 per cent, N2O 66 per cent, and pancuronium 0.05 mg.kg-1, which was reversed with neostigmine and atropine (n = 60). The incidence of vomiting with SV was 50 per cent (95 per cent confidence limits: 34.5-65.5 per cent) compared with 40 per cent (24.5-55.5 per cent) with IPPV (p greater than 0.25). Patients in the SV group experiencing emesis had longer operations than those not vomiting (mean +/- SEM = 1.5 +/- 0.1 vs 1.2 +/- 0.1 hours, p less than 0.005). This was not the case with IPPV. There was no correlation between age, sex, duration of surgery, or number of extraocular muscles repaired, and frequency or severity of vomiting or time to discharge. No significant advantage was afforded by IPPV over SV in the present study.

Child↗
PubMed1995

Midazolam reduces vomiting after tonsillectomy in children.

The purpose of this study was to assess the effect of midazolam on vomiting after tonsillectomy in children. We compared 215 children aged 1.5-14 yr undergoing tonsillectomy or adenotonsillectomy under general anaesthesia with nitrous oxide and halothane. In a double-blind fashion the subjects were administered either placebo or midazolam 75 micrograms.kg-1 iv after induction of anaesthesia. After the operation, the number of emetic episodes and the length of stay in hospital were recorded. The groups were similar with respect to age, weight, sex, mode of induction, duration of anaesthesia, surgical procedure, opioid administration and length of stay in the PAR and the Day Care Surgical Unit. The 108 midazolam-treated children had a lower incidence (42% vs 57%) of vomiting than the placebo group, P < 0.02. The placebo group had a higher incidence (9% vs 2%) of unscheduled admissions to hospital due to nausea and vomiting, P < 0.05. It is concluded that midazolam administered intravenously to children intraoperatively reduces vomiting after tonsillectomy.

Adenoidectomy↗
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↗
PubMed1997

Perphenazine decreases vomiting by children after tonsillectomy.

PURPOSE: To test the hypothesis that perphenazine decreases the incidence of vomiting by children after tonsillectomy. METHODS: Healthy children (n = 260) aged 2-12 yr undergoing elective tonsillectomy on a day care surgical basis were studied in this randomised. stratified, blocked, double-blind investigation. General Anaesthesia was induced intravenously with propofol or by inhalation with halothane and N2O. Perphenazine 70 micrograms.kg-1 up to 5 mg or placebo i.v. was administered before surgery. Management of perioperative fluids, emesis and pain were all standardised. RESULTS: The groups were similar with respect to demographic data. There was less vomiting after perphenazine during the first 24 hr after surgery 42% (95% CI = 34%-50%) vs 57% (95% CI = 48%-66%, placebo), P < 0.01. On the day of surgery, both in and out-of hospital emesis were decreased by perphenazine. The perphenazine treated patients required fewer rescue antiemetics than the control group, P < 0.05. Each episode of in-hospital vomiting delayed discharge by 20 +/- 7 min (mean +/- SD), P = 0.007. CONCLUSION: The prophylactic administration of perphenazine decreases vomiting by children after tonsillectomy.

Antiemetics↗
PubMed1996

Granisetron reduces vomiting after strabismus surgery and tonsillectomy in children.

PURPOSE: To evaluate the antiemetic efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, on postoperative vomiting in children undergoing general anaesthesia for strabismus repair and tonsillectomy with or without adenoidectomy. METHODS: In a randomized, placebo-controlled, double-blind study, fifty patients, 4-10 yr of age, were given a single dose of either placebo (saline, n = 25) or granisetron (40 micrograms.kg-1, n = 25) iv over 2-5 min after the induction of anaesthesia and prior to the surgical procedure. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded. RESULTS: There were no differences between the two groups with regard to patient characteristics, surgical procedures and anaesthetic or postoperative management. The incidence of retching was 36% and 12% after administration of placebo or granisetron, respectively (P < 0.05); the corresponding frequencies of vomiting were 32% and 8% (P < 0.05). Four children who had received placebo required another rescue antiemetic drug, whereas none who had received granisetron needed this agent. CONCLUSION: Granisetron is effective in the prevention of retching and vomiting after strabismus repair and tonsillectomy in paediatric patients.

Antiemetics↗
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↗
PubMed2003

Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy.

PURPOSE: Previous studies on dexamethasone's antiemetic and analgesic potential in children undergoing tonsillectomy have produced conflicting results. The aim of this study was to evaluate the effects of a single dose of dexamethasone on the incidence and severity of postoperative vomiting and pain in children undergoing electrocautery tonsillectomy under standardized general anesthesia. METHODS: In a double-blinded study, 120 patients were randomly allocated to receive either dexamethasone 0.5 mg.kg(-1) (maximum dose 8 mg) iv or an equivalent volume of saline preoperatively. The incidence of early and late vomiting, need for rescue antiemetics, time to first oral intake, time to first demand of analgesia and analgesic consumption were compared in both groups. Pain scores used included Children's Hospital Eastern Ontario Pain Scale, "faces", and a 0-10 visual analogue pain scale. RESULTS: Compared with placebo, dexamethasone significantly decreased the incidence of early and late vomiting (P < 0.05, P < 0.001 respectively). Fewer patients in the dexamethasone group needed antiemetic rescue (P < 0.01). The time to first oral intake was shorter, and the time to first dose of analgesic was longer in the dexamethasone group (P < 0.01). Pain scores 30 min after extubation were lower (P < 0.05) in the dexamethasone group. At 12 and 24 hr postoperative swallowing was still significantly less painful in the dexamethasone group than in the control group (P < 0.01). CONCLUSION: Preoperative dexamethasone 0.5 mg.kg(-1) iv reduced both postoperative vomiting and pain in children after electrocautery tonsillectomy.

Anesthesia, General↗
PubMed1991

Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle.

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four group on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre + menstrum) (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15) and luteal phase (Pd 20-24). The overall incidence of nausea and vomiting was 46%. Statistically significant differences in the incidence of nausea and retching were found among the groups by regression analysis. The incidence of nausea and vomiting was highest in women undergoing laparoscopy during the luteal phase (77%), which was greater than during the follicular phase (32%) or during pre + menstruation (18%). The need for antimetic was highest in women undergoing laparoscopy during the luteal phase (69%) and this was different from the follicular (18%, P less than 0.01) and pre + menstrum (19%, P less than 0.01) phases. It is concluded that the highest incidence of postoperative nausea and vomiting after gynaecological laparoscopy occurs during the luteal phase.

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↗