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PubMed2002

Nausea and vomiting of pregnancy in an evolutionary perspective.

The proximate mechanisms underlying gestational nausea and vomiting have been intensively studied, but the possibility that the symptoms themselves serve a useful function has only recently been considered seriously. We synthesized evidence to evaluate various hypotheses for the adaptive significance of nausea and vomiting of pregnancy, as well as the possibility that symptoms are nonfunctional byproducts of pregnancy hormones. We found greatest support for the hypothesis that normal levels of nausea and vomiting of pregnancy (excluding hyperemesis) protect pregnant women and their embryos from harmful substances in food, particularly pathogenic microorganisms in meat products and toxins in strong-tasting plants. We discuss the data that support critical predictions of this "maternal and embryo protection hypothesis" (and contradict other hypotheses), as well as appropriate implications of these results. Knowledge that normal nausea and vomiting of pregnancy indicates the functioning of a woman's defense system, rather than a bodily malfunction, may reassure patients and enable health care providers to develop new ways of minimizing the uncomfortable symptoms.

Adaptation, Physiological↗
PubMed2002

Maternal susceptibility to nausea and vomiting of pregnancy: is the vestibular system involved?

Nausea and vomiting of pregnancy shares many characteristics with motion sickness, a vestibular dependent phenomenon. A number of physiologic changes that occur in normal pregnancy are also known to accompany nausea and vomiting in patients with motion sickness and certain vestibular disorders. This chapter summarizes some shared features of both phenomena. The unmasking of subclinical vestibular disorders may account for some cases of hyperemesis gravidarum. Hormonal effects on neurotransmitter function may also play a role in nausea and vomiting of pregnancy and in some vestibular disorders; however, the specific neural mechanisms of nausea and vomiting have not been identified. Until the neurochemical processes underlying these phenomena are understood, prevention and management will remain in the domain of astute, but so far limited, clinical observation.

Female↗
PubMed2002

Acupressure and acustimulation bands for control of nausea: a brief review.

We review the published literature examining the efficacy of acupressure and acustimulation wrist bands for the relief of nausea, with special emphasis on the alleviation of nausea associated with pregnancy. We also present preliminary data from an open-label study on the efficacy of acustimulation bands for control of chemotherapy nausea. The literature supports the conclusion that Neiguan-point stimulation by acupressure and acustimulation wrist bands for nausea relief is efficacious for many patients.

Acupressure↗
PubMed2003

Metoclopramide pretreatment attenuates emergency contraceptive-associated nausea.

OBJECTIVE: The study was undertaken to determine whether metoclopramide pretreatment attenuates side effects associated with high-dose estrogen/progestin emergency contraception in at-risk patients. STUDY DESIGN: This was a randomized, prospective, double-blind, placebo-controlled study at the University of Kansas. Patients (141) requesting emergency contraception and lacking contraindications were offered entry in the study. Both the treatment (metoclopramide 10 mg) and placebo groups received active emergency contraception. Participants evaluated symptom severity with a 12-question survey tool developed for this study. RESULTS: Metoclopramide pretreatment provided protection against nausea and cramping associated with estrogen/progestin emergency contraception. The average scores on a 10-point scale for the treatment group and placebo group were as follows: nausea 3.2 versus 4.8 (P =.01) and cramping 0.9 versus 2.2 (P <.01), indicating less severe nausea and cramping in the treatment group. CONCLUSION: Metoclopramide pretreatment attenuates the nausea and cramping associated with Yuzpe emergency contraceptive treatment.

Adult↗
PubMed2005

Effect of i.v. dexamethasone on postoperative dizziness, nausea and pain during canal wall-up mastoidectomy.

CONCLUSION: Prophylactic i.v. administration of 10 mg of dexamethasone reduced postoperative dizziness and nausea without adverse effects in patients undergoing canal wall-up mastoidectomy, but did not reduce postoperative pain. OBJECTIVE: To investigate the efficacy of dexamethasone in reducing postoperative dizziness, nausea and pain in patients undergoing canal wall-up mastoidectomy. MATERIAL AND METHODS: A prospective, randomized, double-blind study was performed between January 2002 and December 2004. A total of 162 patients (66 males, 96 females) scheduled for canal wall-up mastoidectomy were enrolled and randomly assigned to receive either i.v. dexamethasone (10 mg in 2 ml) or i.v. placebo (2 ml of normal saline) during mastoidectomy. A standard general anesthetic technique was employed throughout the surgical procedure. At 3, 6 and 24 h after surgery, patients completed questionnaires regarding postoperative dizziness, nausea and pain, with their responses being given on a visual analog scale. RESULTS: There were no postoperative complications in either group. Compared to the placebo group, the dexamethasone group showed reduced postoperative dizziness and reduced nausea (p<0.05 for both) at 24 h postoperatively. Compared to the placebo group, dexamethasone had no effect on postoperative pain.

Adolescent↗
PubMed2002

Development of an instrument to measure nausea and vomiting in pregnancy.

Severity of nausea, retching and vomiting was determined using a newly developed nausea and vomiting in pregnancy instrument (NVPI) in two groups of pregnant women at two gestational time periods. Participants at Time 1 (approximately gestational week 9), completed a postal questionnaire (N = 643) and those at Time 2 (approximately 13 weeks) completed the instrument at the clinic (N = 284). The three scale items forming the instrument had acceptable internal reliability (Time 1 alpha = 0.76; Time 2 alpha = 0.82). It was noted that approximately 60% of women did not vomit, approximately 30% experienced no retching, but 30-40% experienced nausea either all the time or more than once a day. The instrument may prove to be useful as a research tool to study nausea and vomiting in pregnancy.

Diagnostic Techniques, Digestive System↗
PubMed2004

Psychological health in early pregnancy: relationship with nausea and vomiting.

The psychological health of women in early pregnancy was investigated in a sample of 273 women (mean gestational age 12.8 weeks, SD=2.8) using the General Health Questionnaire (GHQ) and mood and illness perception visual analogue scales, and compared with the prevalence and severity of nausea and vomiting as measured using the Nausea and Vomiting in Pregnancy Instrument (NVPI). Using a cut-off of 4/5 for the GHQ, 50.5% of pregnant women were found to have potential psychiatric problems. However, perceived mental health and physical illness was significantly better than anticipated. The severity of nausea and vomiting correlated independently with GHQ subscales for somatic symptoms, social dysfunction, anxiety/insomnia and severe depression. The contradiction between high GHQ scored and high perceived wellbeing might be explained through cognitive processing. Nausea and vomiting in early pregnancy is associated with psychiatric morbidity. The causal relationship between the two conditions has not been established.

Adolescent↗
PubMed2001

Preoperative oral granisetron for the prevention of postoperative nausea and vomiting after breast surgery.

OBJECTIVE: To evaluate the efficacy and safety of oral granisetron for the prevention of postoperative nausea and vomiting after breast surgery. DESIGN: Prospective, randomised, double-blind, placebo-controlled study. SETTING: University affiliated hospital, Japan. SUBJECTS: 100 women listed for partial or modified radical mastectomy with or without axillary dissection. INTERVENTIONS: Patients were given either placebo or granisetron in three different doses (1 mg, 2 mg, 4 mg) orally 1 hour preoperatively (n = 25 in each group). A standard general anaesthetic technique and postoperative analgesia were used. MAIN OUTCOME MEASURES: All episodes of nausea and vomiting during the first 24 hours after anaesthesia. RESULTS: Complete response, defined as no nausea and vomiting and no need for a "rescue" antiemetic, during the first 24 hours after anaesthesia was recorded in 13 (52%) with placebo, 14 (56%) with granisetron 1 mg, 22 (88%) with 2 mg, and 22 (88%) with 4 mg, respectively (p = 0.006, Fisher's exact test). No clinically serious adverse events were seen in any of the groups. CONCLUSION: Preoperative oral granisetron, in doses of more than 2 mg, is effective for the prevention of postoperative nausea and vomiting in women undergoing general anaesthesia for breast surgery.

Adult↗
PubMed1997

Patients' self-reported functional status after granisetron or ondansetron therapy to prevent chemotherapy-induced nausea and vomiting at six cancer centers.

Patient functional status after administration of either granisetron or ondansetron to prevent acute chemotherapy-induced nausea and vomiting (CINV) was studied. Pharmacists and nurses from six cancer centers distributed Functional Living Index-Emesis (FLIE) questionnaires to 115 outpatients receiving either granisetron or ondansetron for prevention of CINV. The emetogenic potential of each patient's chemotherapy regimen was high, moderately high, or moderate. Immediately before and 72 hours after chemotherapy, each patient rated his or her reaction to each of 18 items on the questionnaire on a 7-point scale. Possible scores ranged from 18 to 126, with higher scores indicating higher levels of functioning. The occurrence of nausea in the granisetron group was 40.0% compared with 43.2% in the ondansetron group; the occurrence of vomiting was 18.8% in the granisetron group and 11.1% in the ondansetron group. Patients who received highly emetogenic chemotherapy had significantly lower scores on the FLIE after chemotherapy than before. Patients with both nausea and vomiting reported a much higher negative impact on functional status after chemotherapy than those with nausea only. The mean prechemotherapy and postchemotherapy FLIE scores were 124.2 and 110.4 for granisetron and 124.9 and 111.9 for ondansetron. Granisetron and ondansetron did not differ significantly in their effect on functional status reported by patients before and 72 hours after receiving cancer chemotherapy.

Adult↗
PubMed1993

Tropisetron in the prevention of chemotherapy-induced nausea and vomiting in patients responding poorly to previous conventional antiemetic therapy.

An open, two-armed, multicentre trial was conducted in 231 patients with malignant disease who had previously failed to respond to conventional antiemetic treatment for the prevention of chemotherapy-induced nausea and vomiting. Patients were randomized to receive either tropisetron (5 mg/day; n = 115) or a standard antiemetic therapy, which was considered optimal for each individual but did not include a 5-HT3 receptor antagonist (n = 116). Acute vomiting on Day 1 was controlled in 60 (52%) tropisetron patients, compared with only 29 (25%) patients receiving optimal standard therapy (p < 0.001). Acute nausea was completely inhibited in 37 (32%) tropisetron patients, compared with 22 (19%) patients on optimal standard therapy (p < 0.05). On Day 1, delayed vomiting was also significantly better prevented by tropisetron (p < 0.001). Side effects from tropisetron (headache and constipation) were mild, and no extrapyramidal symptoms were observed in any tropisetron patients, in contrast, to 14 (13%) patients in the 'optimal standard' group. In conclusion, in cases of acute nausea and vomiting it is more effective to switch refractory patients to tropisetron rather than attempt to optimize the dose of standard antiemetic therapy. For delayed nausea and vomiting, combination antiemetic therapy, with differing types of receptor antagonism and corticosteroids may provide the best way forward. Such studies are in progress.

Antiemetics↗
PubMed1993

Efficacy and tolerability of tropisetron and dexamethasone in the control of nausea and vomiting induced by cisplatin.

A multicentre study was performed at four oncology centres in Sweden, in 160 chemotherapy-naive women, primarily with ovarian or endometrial carcinomas. Abdominal surgery preceded chemotherapy in 146 (91%) women, and another 39 (24%) women had a history of radiotherapy. The chemotherapy regimens contained cisplatin (50-100 mg/m2), in combination with a variety of other agents. In Course 1, all patients received tropisetron (5 mg i.v. Day 1; 5 mg p.o. Days 2-6) and 84% of patients achieved total or partial control of vomiting; 95% of patients achieved total or partial control of nausea during the first 24 hours. Vomiting was least successfully controlled on Day 2 (73% total or partial control) and Days 2-4 for the control of nausea (81, 83, 88% total or partial control, respectively). Patients with partial response in Course 1 (39% of patients) were randomized to addition of dexamethasone or placebo in Course 2. In Course 2, tropisetron plus dexamethasone (Group B2) prevented acute vomiting in 75% of patients, compared with 40% of patients receiving tropisetron plus placebo (Group B1). Over the entire 6 days, there was no vomiting at all in 54% and 20% of B2 and B1 patients, respectively. In Course 2, acute nausea was prevented in 75% of patients (receiving B1) and in 37% of patients (receiving B2). For nausea, over the complete 6 days, the figures were 64% and 3% (p < 0.001). This indicated that patients with incomplete control of emesis in Course 1 benefited from the addition of dexamethasone, provided that it was added for each of the 6 days studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Tropisetron in the prevention of chemotherapy-induced nausea and vomiting: the Nordic experience.

An open, non-comparative, Nordic multicenter study was performed during 1991-1992 to evaluate the new 5-HT3 receptor antagonist tropisetron, as an antiemetic agent in various types of cancer chemotherapy. More than 600 patients were recruited from 16 cancer centers in Sweden, Finland and Denmark. In this report an interim analysis on 231 patients is presented. Gynecological cancers (61%), lung cancer (14%) and breast cancer (7%), were the main diagnoses. In 118 of 231 patients (51%) prior experience of chemotherapy was documented. In 91 patients (39%) cisplatin was part of the cytostatic regimen. Carboplatin (27%), doxorubicin (32%), epidoxorubicin (18%) were also frequently included. In all, 18 cytostatic agents were studied. The median number of courses studied was 3.3 (range 1-15). Overall 153 of 231 patients (67%) were completely protected from acute nausea and vomiting during the first course of chemotherapy. Delayed nausea and vomiting (Days 2-6) were completely controlled in 45%-72%. Treatment efficacy remained stable (57%-89%) over 10 consecutive courses of chemotherapy. For non-cisplatin regimens complete protection was achieved in 78% compared with 51% for cisplatin-regimens (p < 0.0001). Patients with no prior experience of chemotherapy had greater control of acute nausea and vomiting (73%) than patients treated before (61%) in the first course, but not in subsequent courses. There were no such differences in control of delayed nausea and vomiting between chemotherapy-naive and previously treated patients. Sex and age were significant prognostic factors with regard to antiemetic response. Adverse events were recorded in 19%-36% of the cases during long-term follow-up. Headache (16%) and constipation (5%) were most frequent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Double blind comparison of transdermal hyoscine and placebo for the prevention of postoperative nausea.

Transdermal hyoscine (Scopoderm, Ciba-Geigy) has been compared with placebo in 283 female patients. The hyoscine patch had no significant effect on postoperative nausea or vomiting. In contrast with earlier studies, there was no correlation between previous experiences of nausea (motion, pregnancy or surgery related) and nausea caused by the surgery or anaesthetic in this study. No correlation was found between nausea or vomiting and the type of operation.

Administration, Cutaneous↗
PubMed1999

Glycopyrrolate reduces nausea during spinal anaesthesia for caesarean section without affecting neonatal outcome.

We have tested the hypotheses that glycopyrrolate, administered immediately before induction of subarachnoid anaesthesia for elective Caesarean section, reduces the incidence and severity of nausea, with no adverse effects on neonatal Apgar scores, in a double-blind, randomized, controlled study. Fifty women received either glycopyrrolate 200 micrograms or saline (placebo) i.v. during fluid preload, before induction of spinal anaesthesia with 2.5 ml of 0.5% isobaric bupivacaine. Patients were questioned directly regarding nausea at 3-min intervals throughout operation and asked to report symptoms as they arose. The severity of nausea was assessed using a verbal scoring system and was treated with increments of i.v. ephedrine and fluids. Patients in the group pretreated with glycopyrrolate reported a reduction in the frequency (P = 0.02) and severity (P = 0.03) of nausea. Glycopyrrolate also reduced the severity of hypotension, as evidenced by reduced ephedrine requirements (P = 0.02). There were no differences in neonatal Apgar scores between groups.

Anesthesia, Obstetrical↗
PubMed2003

Dolasetron prophylaxis reduces nausea and postanaesthesia recovery time after remifentanil infusion during monitored anaesthesia care for extracorporeal shock wave lithotripsy.

BACKGROUND: Remifentanil is used as an analgesic for different procedures performed during monitored anaesthesia care. Opioid-induced nausea and vomiting can be troublesome. METHODS: This prospective, randomized, double-blind study was performed to evaluate the efficacy of prophylaxis with dolasetron in reducing the frequency of postoperative nausea and duration of discharge time. Forty urological patients, undergoing elective ambulatory extracorporeal shock wave lithotripsy (ESWL) received randomly either dolasetron 12.5 mg i.v. (Group 1) or placebo (Group 2) 10 min before a patient-adapted continuous infusion of remifentanil 0.15-0.4 micro g kg(-1) min(-1) was administered. Frequency and intensity (VAS 0-100 mm) of nausea, retching, and vomiting were assessed by patients and blinded investigators during and after the procedure. RESULTS: Patient characteristics, baseline values, duration of ESWL, and total dose of remifentanil did not differ between groups. The frequency (Group 1/Group 2; 20/55%; P<0.05) and mean (SD) maximal intensity [15 (9)/45 (14) mm; P<0.05] of nausea during 24 h was significantly reduced after dolasetron and discharge times in Group 1 were less than Group 2 [22 (14)/45 (28) min; P<0.05].

Adult↗
PubMed2003

Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy.

BACKGROUND: Supplemental intra-operative oxygen 80% halves the incidence of nausea and vomiting after open and laparoscopic abdominal surgery, perhaps by ameliorating intestinal ischaemia associated with abdominal surgery. It is unlikely that thyroid surgery compromises intestinal perfusion. We therefore tested the hypothesis that supplemental perioperative oxygen does not reduce the risk of postoperative nausea and vomiting (PONV) after thyroidectomy. METHODS: One hundred and fifty patients undergoing thyroidectomy were given sevoflurane anaesthesia. After induction, patients were randomly assigned to the following treatments: (i). 30% oxygen, (ii). 80% oxygen, or (iii). 30% oxygen with droperidol 0.625 mg. RESULTS: The overall incidence of nausea during the first 24 h after surgery was 48% in the patients given oxygen 30%, 46% in those given oxygen 80%, and 22% in those given droperidol (P=0.004). There were no significant differences between the oxygen 30% and 80% groups in incidence or severity of PONV, the need for rescue antiemetics, or patient satisfaction. Droperidol significantly shortened the time to first meal. CONCLUSIONS: Supplemental oxygen was ineffective in preventing nausea and vomiting after thyroidectomy, but droperidol reduced the incidence.

Adult↗
PubMed2004

Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(-1).

BACKGROUND: I.V. fluid administration has been shown to reduce postoperative nausea and vomiting (PONV). The optimum dose is unknown. We tested the hypothesis that administration of i.v. crystalloid of 30 ml kg(-1) would reduce the incidence of PONV compared with 10 ml kg(-1) of the same fluid. METHODS: A total of 141 ASA I female patients undergoing elective gynaecological laparoscopy were randomized, in double-blind fashion, to receive either 10 ml kg(-1) (n=71; CSL-10 group) or 30 ml kg(-1) (n=70; CSL-30 group) of i.v. compound sodium lactate (CSL). RESULTS: In the first 48 h after anaesthesia, the incidence of vomiting was lower in the CSL-30 group than in the CSL-10 group (8.6% vs 25.7%, P=0.01). Anti-emetic use was less in the CSL-30 group at 0.5 h (2.9% vs 14.3%, P=0.04). The incidence of severe nausea was significantly reduced in the treatment group at awakening (2.9% vs 15.7%, P=0.02), 2 h (0.0% vs 8.6%, P=0.04) and cumulatively (5.7% vs 27.1%, P=0.001). The numbers needed to treat to prevent vomiting, severe nausea and antiemetic use in the first 48 h were 6, 5 and 6, respectively. CONCLUSION: I.V. administration of CSL 30 ml kg(-1) to healthy women undergoing day-case gynaecological laparoscopy reduced the incidence of vomiting, nausea and anti-emetic use when compared with CSL 10 ml kg(-1).

Adult↗
PubMed2004

Facial pain increases nausea and headache during motion sickness in migraine sufferers.

The aim of this study was to determine whether trigeminal nerve discharge associated with painful stimulation of the temple would intensify symptoms of motion sickness in migraine sufferers. If so, this would support the notion that symptoms such as nausea and headache interact with each other during attacks of migraine. Symptoms of motion sickness were rated at 2 min intervals during 15 min of optokinetic stimulation in 27 migraine sufferers and 23 age- and sex-matched controls. To document changes in frontotemporal blood flow, pulse amplitude was monitored with photoelectric pulse transducers. To induce facial pain, ice was applied to the temple for 30 s, three times at 4 min intervals during optokinetic stimulation. On another occasion, pain was induced during optokinetic stimulation by immersing the non-dominant hand in 2 degrees C ice water for 30 s, three times at 4 min intervals. On a third occasion, measures were obtained during optokinetic stimulation alone. Migraine sufferers rated themselves as being generally more susceptible to motion sickness than controls. In addition, symptoms of motion sickness provoked by optokinetic stimulation were greater in migraine sufferers than in controls. Painful stimulation of the temple intensified nausea and headache during optokinetic stimulation, whereas painful stimulation of the hand did not. Since nausea also intensifies facial pain during motion sickness, nausea and headache may reinforce each other in a vicious circle. In the absence of painful stimulation, increases in pulse amplitude during optokinetic stimulation were greater in migraine sufferers than controls, possibly because the discomfort associated with motion sickness triggered extracranial vasodilatation in migraine sufferers as part of a fight-or-flight (defense) response. Extracranial vasodilatation did not differ between migraine sufferers and controls when ice was applied to the temple or hand during optokinetic stimulation, implying that the additional discomfort associated with painful stimulation of the head and hand evoked a defense response in controls. These findings suggest that a mechanism which boosts extracranial neurovascular reflexes to stress and which heightens symptoms of motion sickness, increases susceptibility to migraine.

Adult↗