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PubMed2000

The dose-effect relationship for morphine and vomiting after day-stay tonsillectomy in children.

A dose-response curve for intravenous morphine and vomiting was investigated in children having day-stay tonsillectomy. A retrospective chart review was performed for the 164 children fulfilling the inclusion criteria. Morphine (mean 0.09 mg/kg SD 0.05) was used in 108 children in the perioperative period and a further 56 children were given no opioid. Fifty-five of these 164 children vomited and 20 children required an overnight stay in hospital because of vomiting. The probability of vomiting or overnight stay in hospital was related to morphine dose (by logistic regression). The overall probability of vomiting after morphine 0.1 mg/kg was 50% and the probability of admission for vomiting with this dose was 10%. Pharmacodynamic parameter estimates for postoperative vomiting were P0 (the baseline probability of vomiting, with no opioid) 0.115, Pmax (the maximal probability of vomiting due to morphine) 0.997, ED50 (morphine dose that induces an effect equivalent to 50% of the logit Pmax) 0.18 mg/kg. Parameter estimates for overnight stay because of vomiting after morphine administration were P0 0.038, Pmax 0.999, ED50 0.369 mg/kg. Satisfactory postoperative analgesia in children has been reported with morphine 0.05 to 0.15 mg/kg. Doses above 0.1 mg/kg are associated with a greater than 50% incidence of vomiting. Our data suggests that lower doses of morphine are associated with a decreased incidence of emesis after tonsillectomy in children.

Adolescent↗
PubMed1998

Heterogeneity of diagnoses presenting as cyclic vomiting.

OBJECTIVE: To establish the diagnostic profile in children who present with cyclic vomiting. METHODS: We studied 225 children < 18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews. RESULTS: The largest diagnostic category included idiopathic cyclic vomiting syndrome (88%). Extraintestinal disorders (7%) and gastrointestinal disorders (5%) constituting the probable cause of vomiting were established in those having complete cessation of episodes after therapy. In 12%, serious surgical disorders of the gastrointestinal (malrotation), renal (acute hydronephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorder of fatty acid oxidation) were found. Among those with idiopathic cyclic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, but, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably caused or could contribute to the vomiting. CONCLUSIONS: The cyclic pattern of vomiting is a symptom complex that can be induced by heterogeneous disorders that either cause or contribute to the vomiting. Once the cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.

Central Nervous System Diseases↗
PubMed2006

Acupuncture for nausea and vomiting: an update of clinical and experimental studies.

The objective of this overview is to summarize existing knowledge about the effects of acupuncture-point stimulation on nausea and vomiting. Systematic reviews on postoperative nausea and vomiting, chemotherapy-induced nausea and vomiting, and pregnancy-related nausea and vomiting exist. Several randomised trials, but no reviews, exist for motion sickness. For postoperative nausea and vomiting, results from 26 trials showed acupuncture-point stimulation was effective for both nausea and vomiting. For chemotherapy-induced nausea and vomiting, results of 11 trials differed according to modality with acupressure appearing effective for first-day nausea, electroacupuncture appearing effective for first-day vomiting, and noninvasive electrostimulation appearing no more effective than placebo for any outcome. For pregnancy-related nausea and vomiting, results were mixed. Experimental studies showed effects of P6-stimulation on gastric myoelectrical activity, vagal modulation and cerebellar vestibular activities in functional magnetic resonance imaging. There is good clinical evidence from more than 40 randomised controlled trials that acupuncture has some effect in preventing or attenuating nausea and vomiting. A growing number of experimental studies suggest mechanisms of action.

Acupuncture Therapy↗
PubMedDate not supplied

Metaanalysis of acustimulation effects on postoperative nausea and vomiting in children.

OBJECTIVE: Using metaanalysis, we sought to determine acustimulation (AS) effects on postoperative nausea and vomiting (PONV) in children. METHODS: Metaanalyses were performed on various acupoint AS effects including acupressure, acupuncture, laser acupuncture, and electrical stimulation (ETS) on PONV in children. On-line databases were searched for randomized controlled trials (RCTs) from 1966 through May 2005. In addition, the reference lists of reviewed papers were scanned for additional trials. The identified RCTs were evaluated for methodological quality using the Quality Reporting of Meta-analyses (QUOROM) guidelines, and results were pooled using the fixed-effects model. RESULTS: Twelve RCTs were pooled for the outcomes of 24-hour PONV including 12 trials for vomiting and two trials for nausea. Compared with the control groups, all AS modalities reduced vomiting (RR = 0.69, 95% CI: 0.59-0.80, P < .0001) and nausea (RR = 0.59, 95% CI: 0.46-0.76, P < .0001). Acupressure (two trials) and acupuncture (six trials) modalities were effective in reducing vomiting (P < .005); however, ETS (two trials) did not show significant effects in reducing the vomiting (P = .118) in children. Compared with the controls, medications (three trials) reduced vomiting (RR = 0.42, 95% CI: 0.22-0.7, P = .0056). There were no differences between the medication and AS treatments (three trials) in reducing vomiting (RR = 1.25, 95% CI: 0.54-2.93, P = .6025). CONCLUSIONS: This metaanalysis demonstrated that acupressure and acupuncture are effective treatment modalities to reduce postoperative vomiting in children. Acupuncture treatment is as effective as medications to reduce vomiting in children. Acupuncture had the greatest impact on reducing vomiting when compared with acupressure and ETS in children.

Acupressure↗
PubMed1987

Rumination and vomiting in Prader-Willi syndrome.

Inability to vomit has been cited as characteristic of Prader-Willi syndrome (PWS). Although post-prandial vomiting after gastric by-pass surgery has been reported, neither vomiting under "typical" circumstances or rumination have been described. Prompted by the discovery of several cases of vomiting and rumination, a questionnaire was sent to members of the PWS Association. Approximately 36% (113/313) of affected individuals reportedly experienced at least one episode of vomiting. Induced vomiting was unsuccessful in 9 of 14 cases in whom results were known. However, no complications of Ipecac were reported. We suggest that there is an alteration in the physiologic set-point at which vomiting occurs, leading to a decreased propensity to vomit. Liberal and strict definitions of rumination yielded 15.7% and 10.2% positive responses, respectively. Rumination was associated with a history of vomiting. Enamel deterioration consistent with rumination has been observed, and such changes should be looked for in all PWS children. In several instances, rumination was found to decrease when very strict weight control was lessened. Certain individuals may ruminate under too strict a weight control program, and weight control goals should be evaluated to achieve a reasonable compromise between ideal weight and obesity. Vomiting and rumination do not rule out the diagnosis of PWS.

Adolescent↗
PubMed1987

Nausea and vomiting during acute myocardial infarction and its relation to infarct size and location.

Nausea and vomiting occurring during myocardial ischemia is believed to be associated with inferior wall infarction. However, data supporting such an association are limited, and an alternative hypothesis that cardiac vomiting is related to infarct size has also been advanced. The 2 hypotheses were tested in a cross-sectional study of 265 patients consecutively admitted to the coronary care unit. Nausea or vomiting was a good predictor of myocardial infarction (p less than 0.0001). The odds of having an infarction was 3.14 times greater for patients with nausea or vomiting than for those without these symptoms. Nausea was not a good predictor for inferior wall infarction (p = 0.14): 51% of patients with inferior infarcts had nausea or vomiting and 66% with anterior infarcts had these symptoms. Using peak serum creatine kinase level as an index of infarct size, nausea or vomiting was a good predictor of larger infarction. While 55% of all patients with infarction had nausea or vomiting, for patients with infarctions that produced a peak creatine kinase level of more 1,000 IU/liters, 78% had nausea or vomiting. Sex was a marginally important variable. After adjusting for sex, the presence of nausea or vomiting still predicted infarct size (p less than 0.001). Thus, cardiogenic nausea and vomiting are associated with larger myocardial infarctions but do not suggest infarcts in a particular location.

Creatine Kinase↗
PubMed2006

The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis.

OBJECTIVE: The aim of this study was to specifically determine the impact of a fixed dose of ginger administration, compared with placebo, on the 24-hour postoperative nausea and vomiting. STUDY DESIGN: The design was a systematic review and metaanalysis of trials revealed by searches. Randomized controlled trials comparing ginger with placebo to prevent postoperative nausea and vomiting and postoperative vomiting from Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles, contact of authors, and experts in the field. Two reviewers selected studies for inclusion and independently extracted data. RESULTS: Five randomized trials including a total of 363 patients were pooled for analysis of preventing postoperative nausea and vomiting and postoperative vomiting. The summary relative risks of ginger for postoperative nausea and vomiting and postoperative vomiting were 0.69 (95% confidence interval 0.54 to 0.89) and 0.61 (95% confidence interval 0.45 to 0.84), respectively. Only one side effect, abdominal discomfort, was reported. CONCLUSIONS: This meta-analysis demonstrates that a fixed dose at least 1 g of ginger is more effective than placebo for the prevention of postoperative nausea and vomiting and postoperative vomiting. Use of ginger is an effective means for reducing postoperative nausea and vomiting.

Zingiber officinale↗
PubMed2000

Bitter taste perception and severe vomiting in pregnancy.

Hyperemesis gravidarum or severe vomiting during pregnancy is a condition of elusive etiology that can harm both mother and fetus. This study examined the association between increased bitter-taste perception and history of hyperemesis gravidarum. Bitter-taste perception varies genetically and can be altered with conditions that damage taste-related cranial nerves. Sixty women were divided into high- (n = 21) and low-vomit (n = 39) groups based on vomiting exposure across all pregnancies and were screened for genetic variation in taste with bitterness of saturated 6-n-propylthiouracil (PROP) delivered on filter paper. Supertasters perceive PROP as intensely bitter; nontasters, as only weakly. Each reported their history of dysgeusia (persistent taste) and taste-related pathology (otitis media and head trauma). The vomit groups did not differ in the frequency of supertasters, but the high-vomit group had fewest nontasters. The high-vomit group also reported dysgeusia most frequently. A subsample (13 high-vomit and 18 low-vomit women) rated the taste intensity of sodium chloride (1 mol), sucrose (1 mol), citric acid (0.0032 mol), and quinine hydrochloride (0.001 mol) applied to areas innervated by cranial nerves VII and IX. The groups only varied significantly in bitterness of quinine hydrochloride. High-vomit women tasted least bitterness on the anterior tongue (chorda tympani branch of VII) and highest bitterness on the posterior tongue (cranial nerve IX) and palate (superficial petrosal branch of VII). In high-vomit women, elevated bitterness on the posterior tongue and palate does not appear related to hydrochloric acid exposure in vomitus; it may explain the occurrence of dysgeusia. This pattern of spatial taste perception may indicate altered oral sensations that if present during pregnancy, could increase the risk of hyperemesis.

Adult↗
PubMed1998

Ondansetron in the prophylaxis of postoperative vomiting: a meta-analysis.

STUDY OBJECTIVES: To assess the efficacy of ondansetron and the incidence of headache when used as prophylaxis for postoperative vomiting. DATA SOURCES: Studies were identified using MEDLINE (January 1990 to July 1997) with the key words: "vomiting," "ondansetron," and "surgery" and/or "anesthesia." STUDY SELECTION: All prospectively randomized trials in which ondansetron and placebo had been administered for prevention of postoperative vomiting. DATA EXTRACTION: Data on patient numbers, gender and ages, drug dosage, outcomes (incidence of vomiting and incidence of headache), time of outcome (up to 8 hrs or up to 48 hrs postoperatively), and baseline risk for vomiting according to type of surgical intervention were extracted. MAIN RESULTS: 48 trials involving 12,078 patients (10,390 adults and 1688 children) met the selection criteria. No evidence was found that the drug became more effective at doses larger than 4 mg. The dose of 8 mg was not statistically demonstrated to be superior (p = 0.558), while that of 1 mg was barely effective. The meta-analysis indicated that when the incidence of vomiting is elevated (e.g., the combined average of the placebo groups of 48%), on the statistical (i.e., hypothetical) grounds of six patients being treated with 4 mg of ondansetron, one will not vomit due to the treatment and, of the rest, two patients would have vomited despite the treatment and three patients would not have vomited anyway. The overall incidence of headache was 7.05% in ondansetron groups versus 6.16% in placebo groups. CONCLUSIONS: While ondansetron is an effective antiemetic with minimal adverse effects, the data obtained on the numbers needed to be treated calculation for prophylaxis of postoperative vomiting should be considered in future cost-effective strategies of postoperative management.

Administration, Oral↗
PubMed1999

Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery.

STUDY OBJECTIVES: To determine the incidence of postoperative nausea and vomiting when a combination of ondansetron and promethazine is given prophylactically, and to ascertain the effect of postoperative nausea and vomiting on recovery room duration and patient satisfaction. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University-affiliated tertiary-care hospital. PATIENTS: 87 ASA physical status I and II adult patients scheduled for middle ear surgery. INTERVENTIONS: Patients were randomly assigned to receive one of the following interventions intravenously: ondansetron 4 mg (Group 1), promethazine 25 mg (Group 2), ondansetron 2 mg plus promethazine 12.5 mg (Group 3, combination), or placebo (Group 4). MEASUREMENTS AND MAIN RESULTS: Independent, study blinded observers recorded complaints of nausea and number of episodes of vomiting for 24 hours following the patient's first response to commands. All patients were contacted the day after discharge to inquire about nausea and vomiting. The awakening time, postanesthesia care unit and day surgery unit durations, opioid use, and side effects were recorded. At the end of the 24-hour period, the study blinded observers asked patients for an overall assessment of their global anesthesia experience using an 11-point scale. During the 24-hour period, the incidence of postoperative nausea and vomiting was reduced from 74% (placebo) to 39% (promethazine; p = 0.03) and 29% (combination; p = 0.003). Compared with placebo, the severity of vomiting was significantly less in the combination group (p = 0.04). The number of very satisfied patients correlated negatively with the incidence of postoperative nausea and vomiting (p < 0.0001) and with the severity of vomiting (p = 0.003). CONCLUSION: The prophylactic use of an antiemetic with middle ear surgery may reduce postoperative nausea and vomiting over 24 hours, and the ondansetron/promethazine combination or promethazine alone are cost-effective choices. Finally, the combination reduced significantly the severity of vomiting.

Adolescent↗
PubMed2006

Esomeprazole for the prevention of postoperative nausea and vomiting. A randomized, placebo-controlled trial.

BACKGROUND: Postoperative nausea and vomiting still represents a major problem after surgery. Although risk factors for postoperative nausea and vomiting and procedures to reduce postoperative nausea and vomiting have been described, the incidence of postoperative nausea and vomiting remains high. The aim of the present study was to investigate the potential role of the proton pump inhibitor esomeprazole to reduce postoperative nausea and vomiting after elective surgery. METHODS: In a randomized, double-blind trial, ASA I-III patients at high risk for postoperative nausea and vomiting received esomeprazole tablets 3 x 40 mg or matching placebo the evening before surgery, 2 h preoperatively and 24 h postoperatively. Total intravenous anaesthesia with propofol and remifentanil without nitrous oxide (FiO2 0.5) was used. Patients were interviewed using a standardized postoperative nausea and vomiting questionnaire at discharge from the post-anaesthesia care unit, 6 h and 24 h later. The severity of nausea was estimated on a 0-100 point numerical scale (0 = no nausea, 100 = maximum nausea). RESULTS: The incidence of vomiting was similar in the esomeprazole (n = 45) and the placebo (n = 48) groups (64.4% vs. 60.5%, P > 0.05). The average nausea score was 17.8 with esomeprazole and was 18.7 with placebo (P > 0.05). Only 24.7% of all patients (esomeprazole 24.4%, placebo 25.0%) did not experience any nausea or vomiting. CONCLUSION: There is no evidence that prophylactic esomeprazole reduces the incidence of postoperative nausea and vomiting or the degree of postoperative nausea.

Adult↗
PubMed2001

Placebo-controlled comparison of dolasetron and metoclopramide in preventing postoperative nausea and vomiting in patients undergoing hysterectomy.

BACKGROUND AND OBJECTIVE: In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of dolasetron and metoclopramide in preventing postoperative nausea and vomiting in women undergoing hysterectomy. METHODS: Patients were allocated randomly to one of three groups: group A (n = 50) received 50 mg dolasetron orally, group B (n = 50) received 20 mg metoclopramide intravenously and placebo orally, group C (n = 50) received placebo orally. If patients complained of retching or vomiting, or if patients demanded an antiemetic, 1.25 mg droperidol was administrated intravenously. To quantify postoperative nausea and vomiting the following score was used: 0 = no nausea, 1 = nausea, 2 = retching, 3 = single vomiting, 4 = multiple vomiting. The Raatz test was used to analyse postoperative nausea and vomiting (PONV) scores. RESULTS: Dolasetron reduced the postoperative nausea and vomiting score significantly (P < 0.02 vs. metoclopramide; P < 0.0001 vs. placebo). Metoclopramide also reduced the postoperative nausea and vomiting score (P < 0.02 vs. placebo). Fisher's exact test showed a significant reduction of vomiting in the dolasetron group compared with metoclopramide-treated patients (P < 0.007) and placebo-treated patients (P < 0.000006) and a significantly lower rate of nausea in comparison to the placebo group (P < 0.009). There were no significant differences between the metoclopramide and the placebo groups (in Fisher's exact test). The use of postoperative droperidol per patient was significantly lower in the dolasetron group (P < 0.04 vs. metoclopramide; P < 0.0001 vs. placebo) than in the metoclopramide (P < 0.02 vs. placebo) and in the placebo groups. CONCLUSIONS: Oral dolasetron is more effective than either metoclopramide given intravenously or placebo for preventing vomiting after hysterectomy. It also was significantly superior to either metoclopramide or placebo concerning the PONV score and the need for droperidol rescue.

Antiemetics↗
PubMedDate not supplied

Dolasetron decreases postoperative nausea and vomiting after breast surgery.

In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of dolasetron, dexamethasone, and metoclopramide in a preventing postoperative nausea and vomiting in women undergoing breast surgery. Patients were allocated randomly to one of four groups (20 patients each): group A received 12.5 mg dolasetron, group B received 8 mg dexamethasone, group C received 20 mg metoclopramide, and group D received placebo intravenously. If patients complained of retching or vomiting or if patients demanded an antiemetic, 1.25 mg droperidol was administered intravenously. To quantify postoperative nausea and vomiting, the following score was used: 0 = no nausea, 1 = nausea, 2 = retching, 3 = single vomiting, 4 = multiple vomiting. Dolasetron and dexamethasone reduced the postoperative nausea and vomiting score significantly (p < 0.02 versus metoclopramide; p < 0.0001 versus placebo). Metoclopramide also reduced the postoperative nausea and vomiting score (p < 0.02 versus placebo). Fisher's exact test showed a significant reduction of vomiting in the dolasetron and dexamethasone groups compared with metoclopramide-treated patients (p < 0.007) and placebo-treated patients (p < 0.000006) and a significantly lower rate of nausea in comparison to the placebo group (p < 0.009). There were no significant differences between the metoclopramide and the placebo groups (using Fisher's exact test). The use of postoperative droperidol was significantly lower in both the dolasetron group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo) and dexamethasone group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo), as well as in the metoclopramide group (p < 0.02 versus placebo). Intravenous dolasetron and dexamethasone were equally effective and both are more effective than metoclopramide for preventing vomiting after breast surgery. Also both were significantly superior to either metoclopramide or placebo for postoperative nausea and vomiting and the need for droperidol rescue.

Antiemetics↗
PubMed1989

The oculo-emetic reflex. A rationalisation of postophthalmic anaesthesia vomiting.

Data related to the incidence of postoperative vomiting were collected during prospective studies on 607 ophthalmic surgical patients of all ages who underwent halothane anaesthesia with spontaneous ventilation. Analysis of data in respect of age, sex and surgical site variables, and time of onset of vomiting, identified a female sex-related vomiting incidence of about 13% and a squint-related vomiting incidence of about 41%; no relationship between age and vomiting was identified. The analyses showed that squint surgery predisposed particularly to emesis, and was associated with a high incidence of both early and delayed vomiting. It is suggested that the apparent absence of an age-vomiting relationship in ocular, and especially squint, surgery, and the high incidence of vomiting, particularly the early vomiting associated only with squint surgery, provide clinical evidence for the existence of an oculo-emetic reflex. Our observations show that intra- and postoperative surgical stimulation of this oculo-emetic reflex is reflected in the incidences of vomiting after ocular surgery.

Adolescent↗
PubMed1995

Single-dose prophylaxis for postoperative nausea and vomiting after major abdominal surgery: ondansetron versus droperidol.

The new antiemetic ondansetron is effective for the prophylaxis and treatment of postoperative nausea and vomiting (PONV), but has been subject to limited comparative evaluation in surgical inpatients. Two hundred and seventy women having abdominal gynaecological surgery were investigated for 24 hours postoperatively in a randomized, double-blind, placebo-controlled study of intraoperative intravenous ondansetron 8 mg (n = 83), droperidol 2.5 mg (n = 89) or saline placebo (n = 87). Patients receiving either ondansetron or droperidol remained likely to vomit, although the incidence was significantly reduced compared with placebo (72% and 83% versus 91%, P < 0.01). Both drugs also resulted in significantly fewer vomiting episodes (P < 0.001), lower nausea scores (P < 0.05) and a lower incidence of patients requiring treatment for PONV (P < 0.01). Compared with droperidol, the risk of vomiting after ondansetron was less (odds ratio 0.5, CI 0.3-1.0). Ondansetron resulted in fewer vomiting episodes (P < 0.05) and a higher percentage of patients free of nausea after six hours postoperatively (P < 0.05). In patients with a past history of PONV, both drugs had a similar short-lived antiemetic effect, reducing the incidence of vomiting and the need for treatment while in the recovery room, but not thereafter. Droperidol was associated with significantly less headache (P < 0.05), but higher early sedation scores (P < 0.05). Although, compared to placebo, both droperidol and ondansetron administered intraoperatively reduced vomiting after major abdominal gynaecological surgery, the incidence during the first 24 postoperative hours was very high in all groups. Ondansetron reduced the risk of experiencing nausea after six hours postoperatively and the risk of vomiting, with respect to the total number of episodes, in the first 24 hours. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV.

Abdomen↗
PubMedDate not supplied

Chemotherapy-induced vomiting in women treated for breast cancer.

PURPOSE/OBJECTIVES: To describe the incidence and intensity of vomiting in women receiving chemotherapy treatment for breast cancer since the advent of 5-HT3 antagonists. DESIGN: Longitudinal, descriptive. SETTING: 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital. SAMPLE: Typical participants (N = 303) were 51.9 years, Caucasian (79%), married or partnered (65%), born U.S. citizens (93%), heterosexual (96%), living with someone (84%), and high school graduates (82%). METHODS: Baseline and poststudy questionnaires and a daily diary of vomiting through two cycles of chemotherapy (approximately two months) were used to collect data. MAIN RESEARCH VARIABLE: Vomiting experience. FINDINGS: The worst vomiting occurs three days after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. No demographic factors were associated with acute vomiting at times 1 or 2; younger age (r = -0.16; p = 0.012) was associated with more vomiting. Delayed vomiting was associated with age and body mass index, and younger, heavier women experienced more vomiting. Minority women (n = 55) reported significantly more delayed vomiting than did Caucasian women (mean = 6.56 versus 2.82; t = 2.02; p less than 0.05). CONCLUSIONS: Vomiting continues to be a significant problem for some women receiving chemotherapy for breast cancer. IMPLICATIONS FOR NURSING: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer and to support efforts to provide appropriate symptom management for these women.

Adult↗
PubMed2000

Tropisetron: an update of its use in the prevention of chemotherapy-induced nausea and vomiting.

UNLABELLED: Tropisetron is a serotonin (5-hydroxytryptamine; 5-HT) antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. Antagonism of 5-HT3 binding sites in the peripheral and central nervous system is the probable mechanism of prevention of acute nausea and vomiting. Effects on delayed nausea and vomiting are less well understood as these are probably not mediated solely by 5-HT3 receptors. Tropisetron monotherapy is effective for the control of acute, and to a lesser extent delayed, nausea and vomiting in patients receiving moderately to severely emetogenic chemotherapy. The combination of dexamethasone and tropisetron is more effective than monotherapy. Complete control of cisplatin-induced nausea and vomiting was obtained in 69 to 97% of patients receiving the combination compared with 46 to 80% receiving tropisetron monotherapy in randomised trials. There were generally no significant differences between the control of acute or delayed nausea and vomiting provided by tropisetron, ondansetron or granisetron in randomised, comparative trials. The antiemetic efficacy of tropisetron was maintained over multiple cycles of chemotherapy. Most comparative studies showed tropisetron monotherapy to be more effective than metoclopramide in controlling acute nausea and vomiting, with the exception of 1 study which showed similar efficacy. However, high dose metoclopramide plus dexamethasone provided similar control of delayed emesis to tropisetron plus dexamethasone. Tropisetron is also effective in children, including those who responded poorly to previous antiemetic treatment. Tropisetron and ondansetron generally have similar efficacies in this population. The drug enhanced patients' quality of life and was well tolerated by adults and children alike. The recommended oral and IV dosage of tropisetron is 5 mg once daily; there is no increase in efficacy with doses >5 mg. CONCLUSIONS: Tropisetron is similar to other 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting in both adults and children. It is suitable as first-line therapy (combined with a corticosteroid) for the prevention of acute nausea and vomiting in patients treated with moderately to severely emetogenic chemotherapeutic agents. This combination is also moderately effective in the prevention of delayed nausea and vomiting.

Animals↗
PubMed2003

Difference in risk factors for postoperative nausea and vomiting.

BACKGROUND: It is commonly stated that risk factors for postoperative nausea are the same as for vomiting. The authors designed a prospective study to identify and differentiate the risk factors for postoperative nausea and vomiting in various surgical populations in a clinical audit setting. METHODS: The study included 671 consecutive surgical inpatients, aged 15 yr or more, undergoing various procedures. The study focused on postoperative nausea visual analog scale scores every 4 h and vomiting episodes within 72 h. Both vomiting and retching were considered as emetic events. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. The bivariate Dale model for binary correlated outcomes was used to identify selectively the potential risk factors of postoperative nausea and vomiting. RESULTS: Among the 671 patients in the study, 126 (19%) reported one or more episodes of nausea, and 66 patients (10%) suffered one or more emetic episodes during the studied period. There was a highly significant association between the two outcomes. Some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, and general anesthesia). History of migraine and type of surgery were mainly responsible for nausea but not for vomiting. The predictive effect of risk factors was controlled for postoperative pain and analgesic drugs. CONCLUSION: This study shows that differences exist in risk factors of postoperative nausea and vomiting. These could be explained by differences in the physiopathology of the two symptoms.

Adolescent↗