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PubMed1999

[Postoperative nausea and vomiting following stabismus surgery in children. Inhalation anesthesia with sevoflurane-nitrous oxide in comparison with intravenous anesthesia with propofol-remifentanil].

BACKGROUND: Postoperative nausea and vomiting (PONV) is still one of the major problems in strabismus surgery, especially in children. In recent years many studies have been published, suggesting that choosing propofol as the anaesthetic agent may help to reduce the high incidence of PONV in children undergoing strabismus surgery. Experience with remifentanil in children is still very limited and little is known, whether propofol in combination with this new short acting opioid is also superior regarding PONV in squint surgery compared to sevoflurane/N2O. Additionally, little is known, whether the type of operation or the muscle which is operated on has any influence with respect to PONV. METHODS: Following sample size estimation, ethics committee approval and parents informed consent in a prospective, randomised, observer-blind study 105 ASA I and II children aged 3-8 years scheduled for elective strabismus surgery were assigned into one of the following groups: Group TIVA (propofol/remifentanil, n = 53): anaesthesia was induced by remifentanil 0.5 microgram kg-1 min-1 over 2 min (loading phase), followed by 3 mg kg-1 propofol along with 30% O2 in air. After endotracheal intubation anaesthesia was maintained initially with remifentanil 0.25 microgram kg-1 min-1 and propofol 10 mg kg-1 h-1 by constant infusion. In the course of the operation the infusions of the anaesthetics were adjusted to the decreasing need for anaesthesia. Group VOLATIL (sevoflurane/N2O, n = 52): anaesthesia was induced by inhalation of sevoflurane along with 50% O2 in N2O. After endotracheal intubation anaesthesia was maintained with sevoflurane 1.0-1.5 MAC along with 30% O2 in N2O and in the course of the operation the administration of the inhaled anaesthetics was adjusted correspondingly. Preoperatively collected data included gender, age, weight and history of PONV. Intraoperatively collected data consisted of data belonging to routine monitoring (heart rate, blood pressure, peripheral oxygen saturation and temperature) as well as the duration of the operation and anaesthesia and specific data regarding the operation (including the number and type of muscles as well as the kind of operation). Data collected within the first 24 hours postoperatively in the recovery room and on the ward by blinded observers included any PONV events as well as the antiemetics and analgesics applied. RESULTS: Vomiting was observed less frequently in the TIVA-group than in the VOLATIL-group (21 of 53 vs. 32 of 52, p = 0.03) within the first 24 hours postoperatively. Posterior fixation suture ("faden-operation") compared to other operations was followed rather frequently by nausea and vomiting (30 of 44 and 33 of 44, respectively), whereas recessions were rarely associated with nausea and vomiting (12 of 35 and 9 of 35, respectively). CONCLUSIONS: TIVA with propofol/remifentanil proved to be a suitable form of anaesthesia for children in this setting. Propofol showed advantages over sevoflurane/N2O with respect to PONV after squint surgery in children also when applied in the combination with remifentanil. TIVA with propofol/remifentanil may therefore be one way to reduce the high incidence of PONV in this setting, bearing in mind, that PONV is not only influenced by the regimen of the general anaesthesia but rather by the combination of many other factors, in particular the type of operation.

Anesthesia, Inhalation↗
PubMed1999

[Validation of a risk score for prediction of vomiting in the postoperative period].

BACKGROUND: A risk score to predict postoperative vomiting was presented in a recent issue of this journal. In the present study this score was evaluated at another hospital under different surgical and anaesthetic conditions. Furthermore, we examined whether the score, which was originally designed to predict the occurrence of postoperative vomiting (POV) only, is also useful for prediction of postoperative nausea and vomiting (PONV). METHODS: The risk score was applied to 226 patients undergoing inpatient orthopaedic surgery under standardised general anaesthesia (propofol, desflurane in N(2)O/O(2), fentanyl, vecuronium, postoperative opioid analgesia). For 24 hours postoperatively, the patients were followed up for the occurrence of nausea, retching, and vomiting. Perioperatively, risk factors for POV were recorded (gender, age, smoking habits, history of previous PONV or motion sickness, duration of anaesthesia). Using these risk factors the individual risk for suffering POV was calculated for each patient. With these data two ROC-curves (for prediction of POV and PONV respectively) were constructed and the area under the ROC-curve (AUC) as a means of the prediction probabilities of the score was calculated. RESULTS: The incidence of POV as predicted by the score (22,8%) fits well to the actual incidence of this event (19,5%). The score predicts the occurrence of POV significantly better than can be expected by a random estimation. In spite of different surgical and anaesthetic conditions, the accuracy of the prediction in the present dataset was not significantly different from that reported by the authors of the scores in their validation set. Furthermore, the prediction properties for POV (AUC: 0,73) were not different from the prediction of PONV (AUC: 0,72). CONCLUSION: The present risk score provides valid prognostic results even under modified surgical and anaesthetic conditions, and, thus, may obviously be applied to other institutions. Furthermore our results support the hypothesis, that individual risk factors rather than the type of surgery or anaesthetic management have a major impact on the occurrence of POV and PONV.

Adult↗
PubMed2003

Granisetron: is there a dose-response effect on nausea and vomiting?

PURPOSE: Nausea and vomiting are two of the most debilitating side effects of cytotoxic chemotherapy. Prevention of nausea and vomiting is, thus, very important to ensure that cancer patients continue to receive optimal cytotoxic therapy while seeking to maintain their quality of life. Significant advances in antiemetic therapy have been achieved since the introduction of the 5-HT(3) receptor antagonists, and these agents are currently regarded as first-line antiemetic agents. The aim of this article is to examine the hypothesis that there is a dose-response effect of granisetron for preventing chemotherapy-induced nausea and vomiting in cancer patients. METHODS: A literature review of relevant publications was undertaken to provide a comprehensive review of issues related to the control of chemotherapy-induced emesis with escalating doses of granisetron. RESULTS: There is evidence to suggest that there is a significant trend towards an improved efficacy of granisetron-in both the control of emesis and secondary end-points such as nausea and anorexia-with increasing doses, up to 40 micro g/kg, in adults. At this dose, the likelihood of treatment success may be enhanced for most patients regardless of their individual emetogenic risk. Additionally, incremental doses of granisetron (up to 9 mg) have been shown to be effective and well tolerated in patients with refractory emesis. CONCLUSIONS: Those patients experiencing inadequate control of nausea and vomiting following granisetron may also benefit from retreatment with supplementary doses of granisetron, and over subsequent chemotherapy cycles, these patients should receive granisetron 40 micro g/kg to ensure emesis protection.

Animals↗
PubMed2003

Positive serology for Helicobacter pylori and vomiting in the pregnancy.

INTRODUCTION: Recently, several investigators have suggested that H. pylori may be a contributory factor in hyperemesis gravidarum. The purpose of this study was to evaluate whether seropositivity for IgG antibodies to H. pylori may also be related to nausea, vomiting, heartburn and epigastric pain in pregnancy. MATERIALS AND METHODS: One hundred and eighty-five women, at term pregnancy, were included in the study. All women completed a questionnaire regarding information on the number of pregnancies and deliveries, weight gain, smoking and gastrointestinal complaints before and during pregnancy. The presence of H. pylori infection was determined by serology. RESULTS: The overall prevalence rate of H. pylori seropositivity was 45.9%. Women positive for H. pylori IgG were older (28.7+/-4.5 vs. 27.0+/-4.5, p=0.02), had more prior pregnancies (3.2+/-2.1 vs. 2.6+/-1.6, p=0.02) and deliveries (2.6+/-1.6 vs. 2.0+/-1.1, p=0.006) and reported vomiting in the first trimester more frequently than H. pylori negative patients (81.2% vs. 65%, p=0.004). On the other hand vomiting in the second trimester was reported more frequently among smokers during pregnancy compared to non-smokers. CONCLUSIONS: H. pylori seropositivity is significantly associated with emesis gravidarum but not with gastro-intestinal symptoms later in pregnancy. First trimester vomiting more than doubles the likelihood that the gravida is H. pylori IgG positive.

Adult↗
PubMed2002

Tropisetron vs ondansetron for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a randomized double-blind, placebo-controlled study.

BACKGROUND: Postoperative nausea and vomiting are observed in increased frequency after laparoscopic surgery. This study was performed in order to compare the efficacy of two 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, ondansetron and tropisetron, in preventing postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. METHODS: Using a randomized, double-blind study design, 87 ASA I and II patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive 4 mg ondansetron (Group A, n = 29), 5 mg tropisetron (Group B, n = 31), or placebo (Group C, n = 27) intravenously (IV) before induction of anesthesia. The end points evaluated were frequency of nausea, nausea intensity rated on a scale from 1 (mild) to 5 (most severe), frequency of vomiting, and need for rescue antiemetics. These parameters were measured immediately after surgery (0 h), at 3 h, 6 h, and 12 h postoperatively. RESULTS: The frequency of nausea was significantly higher in group A (31.2%) compared to group B (14%) at 12 h postoperatively (p <0.01). However, patients of group A had significantly lower nausea scores at 3 h postoperatively compared to group B. Postoperative vomiting occurred in 13.8% of patients in group A and 9.6% of patients in group B throughout the whole study period (p = n.s.). The need for rescue antiemetics was similar between groups A and B. Both groups were superior to placebo concerning all studied parameters. CONCLUSION: Our results show that ondansetron may be more effective in controlling nausea intensity during the first 3 h after laparoscopic cholecystectomy, while tropisetron has a longer-acting activity, with a major impact on nausea frequency at 12 h postoperatively.

Adult↗
PubMed2006

Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: A prospective randomized study was performed to assess the value of some individual risk factors for postoperative nausea and vomiting (PONV), and to compare the efficacy of ondansetron, metoclopramide, dexamethason, and combinations of these antiemetics in preventing PONV in patients after laparoscopic cholecystectomy. METHODS: The study enrolled 210 patients (157 women and 53 men) scheduled for laparoscopic cholecystectomy. The patients were randomly divided into seven groups. In groups 1 to 6, antiemetic drugs were administered. Group 7, the control group, received no antiemetic. For all the patients, individual risk factors for the incidence of nausea also were analyzed. Both nausea and vomiting were assessed separately 1, 4, 8, and 12 h after the procedure. RESULTS: Postoperative nausea and vomiting were significantly less frequent in menopausal women and more frequent in patients with a history of motion sickness. A comparison of mean values for the incidence of nausea and vomiting in groups 1 to 6 with the same values in group 7 showed that the mean PONV incidences were highest in groups 3 and 7, and the difference was significant. CONCLUSIONS: Administration of antiemetic drugs significantly decreases the incidence of PONV in patients after laparoscopic cholecystectomy. The best decreases were achieved when ondansetron and dexamethason were applied together.

Adult↗
PubMed2006

The impact of chemotherapy-induced nausea and vomiting on health-related quality of life.

GOAL OF WORK: The objectives of this prospective observational study were to estimate the frequency of patients who reported an impact of chemotherapy-induced nausea and vomiting (CINV) on their daily life and to evaluate the determinants of such an impact. MATERIALS AND METHODS: Adult cancer patients at seven Italian oncology centers who were receiving cisplatin-containing regimens reported incidence and intensity of CINV for eight consecutive days in a diary and completed a Functional Living Index for Emesis (FLIE) questionnaire. MAIN RESULTS: Overall, 34% of patients reported vomiting and 62% reported nausea after chemotherapy. On days 1 to 5 after receiving chemotherapy, 67% of patients who had at least one emetic episode and 77% of those who suffered from at least mild nausea experienced an impact on their daily activities as measured on the FLIE questionnaire. More than 90% of all patients with both acute and delayed nausea or vomiting reported an impact on their daily life. Both acute and delayed vomiting contributed in similar measure to impact daily life; however, the importance of delayed nausea was greater than that of acute nausea. CONCLUSIONS: Despite antiemetic prophylaxis, CINV is still prevalent and often impacts the daily life of patients in Italy, especially in the delayed phase. The duration more than the severity seems to be responsible for the impact of CINV on the patients' daily lives.

Aged↗
PubMed1983

Vomiting as a learned weight-control technique in bulimia.

Twenty-seven consecutive patients presenting with binge eating and vomiting were systematically questioned about the circumstances surrounding the onset of their vomiting habit. Twenty-four were able to specify and describe a particular incident to which they attributed the idea of vomiting as a weight-control method. The nature of the reported incidents supports the hypothesis that vomiting in those patients is a learned maladaptive behavior which is frequently inadvertently taught by well-meaning friends, relatives and professionals. These findings indicate the necessity of evaluating the risks as well as the benefits of public education.

Adult↗
PubMed1991

Circadian patterns of cortisol, prolactin, and growth hormonal secretion during bingeing and vomiting in normal weight bulimic patients.

Women who are of normal weight and have bulimia nervosa exhibit multiple neuroendocrine disturbances. We hypothesized that bingeing and vomiting behavior could be contributory because food consumption in healthy volunteers increases plasma cortisol and prolactin secretion and suppresses growth hormone secretion. Thus, we investigated the effects of bingeing and vomiting on the circadian pattern (measurements every 20 min for 24 hr) of these hormones in comparison to healthy control women eating normally. Bingeing and vomiting were associated with modest increases in cortisol and prolactin and reductions in growth hormone secretion. However, this bingeing or purging did not alter mean 24-hr pattern of cortisol and growth hormone secretion as values for bulimics were similar to controls. While mean daytime patterns of prolactin secretion were similar in bulimics and controls, bulimic patients had a significant reduction of nocturnal prolactin levels. In summary, bingeing and vomiting does not appear to have a substantial influence on hormonal secretion. However, bulimic women have blunted nocturnal prolactin patterns.

Adolescent↗
PubMed1981

Perimolysis: unveiling the surreptitious vomiter.

Perimolysis is a dental condition linked to chronic regurgitation. When perimolysis is found in the patient who denies vomiting, one must suspect anorexia nervosa, a disorder with a high rate of morbidity and mortality. The dental literature has not provided guidelines for confirming the suspicion of surreptitious vomiting. The purpose of this case report is to describe our approach, using simple blood and urine studies, which establishes whether a patient who has perimolysis but denies vomiting is a surreptitious vomiter.

Adult↗
PubMed1986

Lack of association between prodromes nausea and vomiting, and specific electrocardiographic patterns of acute myocardial infarction.

We conducted an observational study on 164 patients consecutively admitted to our coronary care unit in order to evaluate the predictive role of cardiac prodromes nausea and vomiting, in distinguishing a particular electrocardiographic pattern (Q wave versus non-Q wave and localisation) of an acute myocardial infarction. Patients with the prodromes made up 47.0% of all Q wave myocardial infarction and 59.4% in those without Q wave myocardial infarction. Furthermore, patients had nausea and vomiting in 25.0% of all Q wave myocardial infarction and in 31.2% of all non-Q wave infarction. No significant differences were found in the patients who experienced nausea and vomiting in the localisation (anterior versus inferior) of myocardial infarction. Our findings indicate that the cardiac prodromes of nausea and vomiting do not play any particular role in predicting a specific electrocardiographic pattern of acute myocardial infarction.

Electrocardiography↗
PubMed2006

Endocrine correlates of acute nausea and vomiting.

This paper gives an overview of studies investigating endocrine changes in acute nausea and vomiting. The aetiology of nausea and vomiting is not fully understood, but it has been shown that different stress hormones are released into circulation during motion sickness. Studies with animals and humans have shown that acute nausea activates the hypothalamo-pituitary-adrenal axis and the neurohypophyseal system. So-called stress hormones, like adrenocorticotropic hormone, cortisol, and antidiuretic hormone, are released concomitant with nausea and vomiting in motion sickness, but do not seem to be involved in the aetiology of motion sickness. Nevertheless, plasma levels of stress hormones more or less correlate to the intensity of nausea related symptoms. Although gastroenteropancreatic hormones are involved in gastrointestinal motility, there are only few data describing their changes in response to acute nausea or vomiting.

Animals↗
PubMed2006

Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery.

OBJECTIVE: Patients who underwent skull base procedures have been noted to experience appreciable pain. This study examines pain after surgery and the effectiveness of patient controlled analgesia (PCA) with combination morphine ondansetron for analgesia and control of emesis. STUDY DESIGN AND SETTING: A total of 120 skull base surgery patients were randomized to receive placebo, morphine, or morphine ondansetron. Demographic and intraoperative variables were recorded along with pain, nausea, vomiting, and rescue analgesics. Total PCA use, hospital stay, satisfaction, and cost were also compared. RESULTS: Demographically the groups were similar. Pain was elevated with placebo PCA, and this group averaged twice as many analgesic rescues. Total usage time was lower with placebo PCA. Morphine ondansetron PCA had the lowest pain score with highest satisfaction. Nausea and vomiting was similar but female patients had more vomiting regardless of PCA group. CONCLUSIONS AND SIGNIFICANCE: The use of morphine PCA reduced pain and did not appreciably increase nausea or vomiting. The addition of ondansetron produced no real benefit and its PCA use cannot be justified. EBM RATING: A-1b.

Adolescent↗
PubMed2006

Low-dose mirtazapine may be successful treatment option for severe nausea and vomiting.

The antagonism of 5-HT3 receptor by mirtazapine results in an antiemetic effect, suggesting that mirtazapine could be considered a successful antiemetic agent in patients suffering from severe nausea and vomiting. There have been several reports of successful mirtazapine treatment for nausea or vomiting from secondary causes but cases of primary severe nausea and vomiting are still lacking, in particular, there are no reported cases in Asians. The authors report two cases with severe nausea and vomiting that were dramatically treated with mirtazapine in the Korean population.

Adult↗
PubMed2000

Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change.

OBJECTIVE: Our purpose was to provide a detailed description of patterns of nausea and vomiting of pregnancy. STUDY DESIGN: A prospective study was performed with 160 women who provided daily recordings of frequency, duration, and severity of nausea and vomiting. RESULTS: Seventy-four percent of women reported nausea lasting a mean of 34.6 days. "Morning sickness" occurred in only 1.8% of women, whereas 80% reported nausea lasting all day. Only 50% of women were relieved by 14 weeks' gestation; 90% had relief by week 22. Data based on the McGill Nausea Questionnaire indicate that the nausea experienced by pregnant women is similar in character and intensity to the nausea experienced by patients undergoing cancer chemotherapy. CONCLUSIONS: Traditional teachings about nausea and vomiting of pregnancy are contradicted by our findings. Standardized tools for measuring the distribution, duration, and intensity of nausea are applicable to the study of nausea and vomiting of pregnancy and could be used in clinical trials to assess palliative measures.

Adult↗
PubMed2000

Granisetron, droperidol, and metoclopramide for the treatment of established postoperative nausea and vomiting in women undergoing gynecologic surgery.

OBJECTIVE: The aim of this study was to evaluate granisetron, droperidol, and metoclopramide for efficacy and safety in the treatment of established postoperative nausea and vomiting after major gynecologic surgery. STUDY DESIGN: One hundred twenty postoperative female patients were monitored for the first 3 hours after anesthesia in the postanesthesia care unit and for the next 24 hours after anesthesia in the ward. Patients who had postoperative nausea and vomiting within the first 3 hours after anesthesia received intravenously, in a randomized double-blind manner, 40 microg/kg granisetron, 20 microg/kg droperidol, or 0.2 mg/kg metoclopramide. Patients were then observed for 24 hours after drug administration. RESULTS: Complete control of established postoperative nausea and vomiting, defined as no emesis and no need for another rescue antiemetic medication, was more frequent among the patients who had received granisetron (88%) than among those who had received droperidol (55%) or metoclopramide (50%) (P <.05). The severity of nausea was less in patients who had received granisetron than in those who had received droperidol or metoclopramide (P <.05). No clinically adverse events were observed in any of the groups. CONCLUSION: Granisetron is more effective than droperidol or metoclopramide for the treatment of established postoperative nausea and vomiting during the first 3 hours after anesthesia in patients undergoing major gynecologic operations.

Adult↗
PubMed2001

Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy.

BACKGROUND: Postoperative nausea and vomiting are significant problems in laparoscopic surgery. This double-blind, randomized, prospective trial compares the prophylactic use of metoclopramide, ondansetron, and placebo for the treatment of postoperative nausea and vomiting in patients undergoing outpatient laparoscopic cholecystectomy. METHODS: Two hundred thirty-two patients aged 18 to 73 years were randomized into three groups. Patients received intravenously 10 mg of metoclopramide, 4 mg of ondansetron, or placebo in a double-blinded manner prior to surgery. RESULTS: The incidence of nausea was 32% for metoclopramide, 45% for ondansetron, and 44% for placebo in the postanesthesia care unit or day surgery, which was not statistically significant. The incidence of vomiting was 8% for metoclopramide, 4% for ondansetron, and 22% for placebo in the postanesthesia care unit or day surgery. These differences were statistically significant when comparing both drugs to placebo but not when comparing both drugs to each other. CONCLUSION: Prophylactic administration of metoclopramide or ondansetron significantly reduces the incidence of postoperative vomiting for laparoscopic cholecystectomy, but neither drug was found to be significantly more effective than the other. Metoclopramide is a more cost-effective treatment.

Adult↗
PubMed2003

A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy.

OBJECTIVE: To evaluate the effectiveness of low-level nerve stimulation therapy over the volar aspect of the wrist at the P6 point to treat nausea and vomiting in early pregnancy. METHODS: Pregnant volunteers (n = 230) with symptoms of mild to severe nausea and vomiting between 6 and 12 weeks' gestation participated in a 21-day clinical trial. Participants were randomly assigned to receive a device for nerve stimulation therapy or an otherwise identical but nonstimulating placebo device. The primary outcome measure was self-recorded symptoms according to the Rhodes Index of Nausea, Vomiting, and Retching (Rhodes Index). Secondary outcome measures were medication use, weight gain, and presence of urinary ketones. RESULTS: Baseline characteristics were similar in both groups. A total of 187 women (81%) completed the trial. Pretreatment Rhodes Index scores for the entire population demonstrated no significant differences between study and control groups. The time-averaged change in Rhodes Index total experience of 6.48 for the study group was significantly better than the control value of 4.65 (P =.02). Study patients gained more weight than controls (2.9 versus 1.2 lb, P =.003). There were no statistically significant differences in medication use or urinary ketone measurements. CONCLUSION: Nerve stimulation therapy is effective in reducing nausea and vomiting and promoting weight gain in symptomatic women in the first trimester of pregnancy.

Acupuncture Therapy↗