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PubMed2000

Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy.

Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996-97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0-1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy. We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.

Adult↗
PubMed1995

Autonomic measures associated with chemotherapy-related nausea: techniques and issues.

Advances in antiemetic therapy for cancer patients have been hindered by a lack of understanding of the physiological mechanisms associated with nausea and their corresponding measurement techniques. Here we review conceptual and methodological issues involved in developing an autonomic frame of reference for nausea and outline two strategies for assessing autonomic function. A primarily research-oriented strategy uses heart rate, blood volume pulse, pallor, and skin temperature to assess autonomic activity and reactivity over 24 hr. Peak values of these measures relative to time of emesis, heart rate spectral analyses of autonomic activity, and analyses of the standard deviation of successive differences of beat-to-beat intervals were all associated with subsequent nausea. A primarily clinically oriented strategy assesses normal and abnormal results on eight common bedside clinical tests of autonomic function. The total number of abnormal tests was associated with subsequent nausea. A better understanding of chemotherapy side effect mechanisms is likely to result in less polypharmacy and more effective individualized treatment for cancer patients.

Arrhythmia, Sinus↗
PubMed2005

[The effects of foot reflexology on nausea, vomiting and fatigue of breast cancer patients undergoing chemotherapy].

PURPOSE: The purpose of this study was to identify the effects of foot reflexology on nausea, vomiting and fatigue in breast cancer patients undergoing chemotherapy. METHOD: The research was a quasi-experimental study using a non-equivalent pre-post design and was conducted from Jan. 26, to Mar. 20, 2004. The subjects consisted of 34 patients with 18 in the experimental group and 16 in control group. A pretest and 2 posttests were conducted to measure nausea, vomiting and fatigue. For the experimental group, foot reflexology, which was consisted of 4 phases for 40 minutes, was given by a researcher and 4 research assistants. The collected data were analyzed by repeated measures ANOVA using the SPSS WIN 10.0 program. RESULTS: There was a statistically significant decrease in nausea, and vomiting in the experimental group compared to the control group over two different times. In addition, there was a statistically significant decrease in fatigue in the experimental group compared to the control group over two different times. CONCLUSION: Foot reflexology was effective on nausea, vomiting and fatigue in breast cancer patients receiving chemotherapy in this study. Therefore, foot reflexology can be usefully utilized as a nursing intervention in the field of cancer nursing for breast cancer patients receiving chemotherapy.

Adult↗
PubMed1998

The impact of the menstrual cycle and ondansetron on postoperative nausea and vomiting.

The incidence of postoperative nausea and vomiting was studied in a prospective group of 94 women of child-bearing age (18-42 years), undergoing unilateral elective thyroid surgery. In a subgroup of 47 examinees the postoperative nausea and vomiting episodes were analyzed according to the time of surgery within their menstrual cycle: the highest occurrence was observed in the periovulatory and premenstrual periods (65.5% vs. 27.8%, p < 0.02). In the formal part of this study, 25 patients randomly received ondansetron (8 mg intravenous [i.v.]): they had significantly less postoperative nausea and vomiting than their 22 placebo controls (4 ml saline i.v.): 16.0% vs. 45.5% (p < 0.04). It is concluded that elective surgery in young and middle-aged female patients is best avoided premenstrually and in the middle of their cycle. In these very periods, however, ondansetron effectively reduces the incidence and intensity of postoperative nausea and vomiting by about 70%.

Adolescent↗
PubMed1999

[Efficacy of combination with granisetron and methylprednisolone for nausea, vomiting and appetite loss in remission induction chemotherapy of acute myeloid leukemia--a randomized comparative trial between granisetron alone and granisetron plus methylprednisolone].

The prevention of nausea, vomiting and appetite loss induced by remission induction chemotherapy for acute myeloid leukemia was compared by randomization between granisetron alone and combination with granisetron plus methylprednisolone. Granisetron was administered at 40 micrograms/kg during chemotherapy, and methylprednisolone was administered concomitantly at 125 mg/body for 3 days or more in the combination group. The single and combination groups comprised 14 and 13 patients, respectively, and there was no significant difference between the background of both groups. To evaluate the effect they were scored according to 4 grades, and evaluated every 24 hours from the start of chemotherapy to 5 days after its completion. The complete inhibition rate of vomiting was as high as 71.4% and 92.3% in the single and combination groups, respectively, showing no significant difference. The grade of vomiting was mild in both groups. Nausea was noted in 71.4% and 46.2%, respectively, and the inhibitory effect tended to be higher in the combination group. Appetite loss developed in 92.9% and 41.7%, respectively, and the prevention effect was clearly higher in the combination group. The prevention effects on nausea 7, 8 and 10 days after the start of chemotherapy, on appetite loss 2-10 days after it, and 2-5 days after its completion, were higher in the combination group. Granisetron revealed an excellent inhibitory effect on vomiting induced by remission induction chemotherapy for acute myeloid leukemia, but combination with granisetron and methylprednisolone was considered useful for nausea in the latter half of the treatment period and for appetite loss during the whole period.

Acute Disease↗
PubMed2000

Appraisal of drug therapy for nausea and vomiting of pregnancy: I. The placebo effect - methodological and practical considerations.

BACKGROUND: Despite that nausea and vomiting of pregnancy (NVP) is the most common medical problem during pregnancy, the placebo effect in the treatment of this condition has not been properly evaluated. METHODS: Two published randomized, controlled trials comparing the antiemetic effects of vitamin B6 with placebo were analyzed. RESULTS: When the severity of nausea or vomiting in the placebo groups at baseline was compared with that at the end of the trials, there was a clear time-dependent placebo effect that peaked between days 4 and 5. The placebo effect appeared to be more pronounced in nausea than in vomiting. CONCLUSIONS: There is a clear placebo effect on NVP. The effect appears to be stronger with nausea than with vomiting.

Female↗
PubMed2001

[Prevention of postoperative nausea and vomiting in gynecologic surgery with 3 fixed doses of metoclopramide, droperidol or placebo].

OBJECTIVES: To compare the efficacy and side effects of three doses of metoclopramide, droperidol or placebo administered every 8 h to prevent nausea and vomiting during the first 24 h after surgery. MATERIAL AND METHODS: Prospective, double blind study of 104 patients scheduled for major intraabdominal gynecological surgery under general anesthesia. The patients were randomly assigned to three groups: group M received 10 mg of metoclopramide, group D received 1.25 mg of droperidol and group P received a saline solution. The patients were premedicated with oral diazepam. All patients were anesthetized using similar techniques, with fentanyl, thiopental, vecuronium, oxygen/nitrogen protoxide and isoflurane. Muscle relaxation was reversed with atropine and neostigmine. Postoperative analgesia was given with endovenous morphine and metamizol. Immediately after surgery each patient received an endovenous dose of the assigned antiemetic drug. Patients were monitored for 24 h and observations were recorded every hour on the following scale: 0, for no emetic symptoms, 1 for nausea and 2 for vomiting. RESULTS: Fifteen patients (42.9%) in group D, 21 (60% in group M and 19 (54.3%) in group P experienced nausea during the 24 h after surgery, with no significant differences. However, the incidence of vomiting was significantly lower in group D, with 7 patients (20%) vomiting in group D versus 11 patients (31.43%) in group M and 17 (50%) in group P. Side effects were mild and required no treatment. CONCLUSIONS: Droperidol at a dose of 1.25 mg every 8 h is effective and safe for preventing postoperative nausea and vomiting and has minimal side effects. Metoclopramide at a dose of 10 mg every 8 h, in our study, was no better for the same purpose than placebo.

Adult↗
PubMedDate not supplied

Ondansetron versus dehydrobenzoperidol and metoclopramide for management of postoperative nausea in laparoscopic surgery patients.

BACKGROUND: In this prospective, randomized, double-blind study, we compared the efficacy of ondansetron versus dehydrobenzoperidol (droperidol) or metoclopramide in the treatment of established postoperative nausea and vomiting in 200 adult patients undergoing laparoscopic surgery under general anesthesia. METHODS: One hundred seventy-three American Society of Anesthesiologists (ASA) I and II patients satisfied inclusion criteria. Fifty-seven patients received ondansetron 4 mg (group O), 57 patients were given droperidol 1.25 mg (group D), and 59 patients received metoclopramide 10 mg (group M). Antiemetic efficacy was compared at 10 minutes and 30 minutes after the administration of the study drug. RESULTS: At 10 minutes, nausea scores in group O dropped from 8.3 to 3.7, in group D from 8.5 to 5, and in group M from 8.4 to 6.7; (P < 0.05 between the three groups). At 30 minutes, nausea scores were 1.3 in group O, 1.7 in group D, and 5 in group M; (P < 0.05 between group M and the other two groups). In the droperidol group, 25% of patients developed sedation. Patient satisfaction was best with ondansetron. CONCLUSIONS: Both ondansetron and droperidol were more effective in the treatment of established postoperative nausea and vomiting than was metoclopramide. However, patients were satisfied best with ondansetron, which acts faster and causes less sedation than droperidol.

Adult↗
PubMed2001

Post-operative nausea and vomiting in out-patient gynecologic laparoscopy: a comparison of thiopental-nitrous oxide, propofol-nitrous oxide and total intravenous anesthesia using propofol.

An intravenous anesthetic drug, propofol was considered to pose antiemetic action. A randomized controlled trial was conducted to evaluate whether propofol could effectively reduce post-operative nausea and vomiting (PONV) compared to thiopental-nitrous oxide (N2O). One-hundred and eight patients undergoing outpatient gynecologic laparoscopy were assigned to receive 3 techniques of anesthesia; thiopental-N2O (T/N), propofol-N2O (P/N) and total intravenous anesthesia (TIVA) using propofol (P/P). The results showed that in the early period (0-5 hours), post-operative nausea in T/N, P/N and P/P groups was 72 per cent, 44 per cent and 31 per cent, respectively (P = 0.002), and post-operative vomiting was 58 per cent, 36 per cent and 11 per cent respectively (P = 0.00014). Patients in the P/N and P/P groups experienced nausea less frequently than the T/N group [relative risk (RR) = 0.62, (95% CI 0.41-0.93) and RR = 0.42 (0.25-0.72) respectively]. Patients in the P/N and P/P groups experienced vomiting less frequently than the T/N group [RR = 0.62 (0.37-1.04) and RR = 0.19 (0.07-0.5) respectively]. Two patients in the T/N group were admitted because of severe nausea and vomiting. In conclusion, TIVA using propofol and propofol-N2O anesthesia can significantly reduce the incidence of PONV in the early period. Concerning the economic crisis of the country as well as the quality of care, propofol-N2O would be the most appropriate anesthetic of choice.

Adult↗
PubMed2001

Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting).

There is some confusion about the contribution of reversal of residual paralysis to the occurrence of postoperative nausea and vomiting. The aim of this review is to discuss whether antagonism of residual paralysis is a cause of postoperative nausea and vomiting, and to assess the risk of residual paralysis if the reversal is omitted. Data from a meta-analysis published before 1998 were considered, along with trials published after that date to assess the influence of reversal of residual paralysis on postoperative nausea and vomiting, and the likelihood of harm when antagonism was omitted. Moreover, an overview of pathophysiological consequences, incidence and clinical consequences of residual paralysis is given and the actual criteria of the adequacy of neuromuscular recovery presented. When emetic outcomes are combined across all trials and all different neostigmine doses, there is no beneficial effect from omitting neostigmine on postoperative nausea and vomiting, but there is some evidence of a dose-responsiveness with neostigmine; higher doses may have emetic properties. However, omitting reversal introduces a non-negligent risk of residual paralysis. An improved understanding of the pathological consequences of residual paralysis (i.e. impaired laryngeal and pharyngeal muscle function, alterations in hypoxic ventilatory control, reduced margin of safety) led to establishment of more rigorous criteria for defining adequacy of neuromuscular recovery. A train-of-four ratio of > or = 0.9 is now accepted as the index of adequate recovery of neuromuscular function. Applying this new definition, residual paralysis becomes a frequent adverse side-effect. Neuromuscular recovery should therefore be routinely monitored in ambulatory patients and residual paralysis prevented by reversing neuromuscular block.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Clinical evaluation of granisetron as an inhibitor of nausea and vomiting induced by oral anticancer drugs.

In order to inhibit the nausea and vomiting induced by oral anticancer drugs, granisetron was administered orally at a dose of 2 mg once a day, and its usefulness and safety were evaluated. The subjects were 26 outpatients with gastric or colon cancer receiving chemotherapy with oral anticancer drugs and complaining of gastrointestinal symptoms. A record sheet was handed to the patients. In comparison with the condition before treatment, the patients were instructed to indicate on the record sheet the severity of nausea (4 grades), presence or absence of vomiting, and degree of appetite (4 grades) after treatment, and thereby to evaluate the clinical efficacy or antiemetic effect every day in accordance with clinical efficacy evaluation criteria of 4 grades (very effective, effective, slightly effective, and ineffective). i) Nausea disappeared in 47.8% of the patients on the 1st day of treatment and in 65.2% on the 5th day of treatment. ii) Vomiting was observed in 2 and 3 patients on the 1st and 3rd day, respectively, but not on the 4th day of treatment or thereafter. iii) The efficacy rate, comprising both very effective and effective, was 69.5% on the 1st day of treatment, and increased gradually to reach 78.2% on the 5th day of treatment. iv) There was no adverse reaction or abnormality of laboratory test values attributable to granisetron. Granisetron was safe and effective against nausea and vomiting induced by oral anticancer drugs.

Administration, Oral↗
PubMed2002

The use of nalmefene for intrathecal opioid-associated nausea in postpartum patients.

The aim of this study was to compare the severity of nausea and incidence of emesis in laboring parturients who received intravenous nalmefene or placebo following an intrathecal opioid (ITO). We randomly assigned 60 ASA class I or II multiparous women to receive nalmefene or placebo. Subjects received fentanyl, 25 micrograms, and morphine, 250 micrograms, intrathecally on request for analgesia. Thirty minutes after vaginal delivery, the experimental group received nalmefene, 20 micrograms, and the placebo group received an equivalent volume of normal saline intravenously. Visual analog scale nausea scores and data about episodes of emesis were obtained during labor and during the first 24 hours postpartum. There were no significant differences in age, weight, duration of labor, volume of intravenous fluids infused, time from last meal to delivery, or time from administration of the ITO to injection of the study drug. There were no significant differences in mean visual analog scale nausea scores or frequency of emesis for any time interval. Nalmefene, 20 micrograms, given intravenously within 30 minutes of vaginal delivery does not significantly reduce the nausea and vomiting associated with the use of ITOs for labor analgesia.

Adult↗
PubMed2002

Pharmacology review: the role of ondansetron in the management of children's nausea and vomiting following posterior fossa neurosurgical procedures.

The management of nausea and vomiting is fundamental to the post-operative nursing care of children. Children who have neurosurgical procedures, especially those that involve the posterior fossa, are likely to experience nausea and vomiting in the post-operative period. The proximity of brainstem emetic centres to the surgical site compounds the usual post-operative risk factors for nausea and vomiting. Ondansetron is discussed as an agent that may be more effective than the traditionally-used antiemetics, such as dimenhydrinate and metoclopramide, in this population. Nurses must advocate for effective therapeutic measures to manage children's post-operative nausea and vomiting. Advocacy requires knowledge of high-risk groups, accurate assessment, timely intervention, and thorough evaluation of pharmacological and non-pharmacological measures.

Antiemetics↗
PubMedDate not supplied

[The efficacy of droperidol, metoclopramide, propofol, and ondansetron for the prevention of nausea and vomiting following middle ear surgery].

OBJECTIVES: The efficacy and reliability of prophylactic antiemetic therapy with low dose propofol, droperidol, metoclopramide, and ondansetron were evaluated in a randomized, double-blind, and prospective design. PATIENTS AND METHODS: A total of 101 ASA I-II patients (34 females, 67 males; age range 16 to 53 years) undergoing middle ear surgery for chronic otitis media or its sequelae were randomly assigned to receive prophylactic antiemetic therapy with propofol (n=21, 0.5 mg/kg), droperidol (n=19, 20 mg/kg), metoclopramide (n=23, 0.2 mg/kg), ondansetron (n=21, 4 mg), and placebo (n=20, 0.9% NaCl). All drugs were administered intravenously five minutes before extubation. RESULTS: In the early postoperative period (0 to 3 hours), the percentages of patients free from nausea and vomiting were 100% with droperidol, 71.4% with ondansetron and propofol, 52.1% with metoclopramide, and 35% with placebo. Ondansetron (90.4%) was found the most effective to prevent and control nausea and vomiting during the postoperative 3 to 24 hours, followed by droperidol (84.2%), propofol (57.1%), metoclopramide (47.8%), and placebo (40%). Compared with controls, the number of patients without nausea and vomiting was significantly greater in each treatment group but metoclopramide (p<0.05). No significant differences were detected with respect to adverse effects. CONCLUSION: Droperidol and ondansetron seem to exert the highest efficacy to prevent nausea and vomiting during the postoperative 0 to 3 hours and 3 to 24 hours, respectively.

Adolescent↗
PubMed2003

Effect of acupressure on postoperative nausea and vomiting in laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the effectiveness of acupressure applied at meridian P6 point for prevention of nausea and vomiting in patients undergoing laparoscopic cholecystectomy. METHODOLOGY: A randomized double blind study was performed in 50 ASA I and II patients scheduled for laparoscopic cholecystectomy. Patients were divided into two groups; control and placebo. In the control group acupressure was applied at P6 point half an hour before surgery while in the placebo group the acupressure band was tied on meridian P6 point but the plastic bead was placed on the dosum of right forearm away from meridian P6 point. Patients were assessed for nausea and vomiting for six hours after surgery. Anaesthetic technique and postoperative analgesia were standardized for all patients. RESULTS: Results showed that the incidence of postoperative nausea and vomiting was 36% in the treatment group and 40% in placebo group, which is statistically insignificant. CONCLUSION: Application of acupressure at P6 point half an hour before induction of anaesthesia does not significantly alter the incidence of postoperative nausea and/or vomiting within 6 hours after surgery.

Acupressure↗
PubMed2003

[Acupuncture for nausea: how does it work?].

Nausea, the unpleasant feeling that one is going to vomit, results from the stimulation of the Chemoreceptor Trigger Zone (CTZ) and Vomiting Center in the brain. Conventional medical therapy is not always effective, and medications often have severe adverse effects. Acupuncture is a treatment in which thin needles (diameter of 0.20-0.30 mm) are inserted into various points along the skin, according to energy channels (meridians) established thousands of years ago. The anti-emetic effects of acupuncture apparently stem from the resultant increase in hypophyseal secretion of beta-endorphins and ACTH, with subsequent inhibition of the CTZ and vomiting center. Acupuncture also affects the upper GI tract, decreasing acid secretion and repressing gastric arrhythmias. Clinical research has found this treatment modality to be effective for nausea, whether it be due to morning sickness in pregnant women, motion sickness in travellers, postoperative nausea or chemotherapy-induced nausea in cancer patients.

Acupuncture Points↗
PubMed2003

The efficacy of ginger in prevention of post-operative nausea and vomiting after outpatient gynecological laparoscopy.

OBJECTIVE: To study the efficacy of ginger in prevention of nausea and vomiting after outpatient gynecological laparoscopy. STUDY DESIGN: Double blind randomized controlled trial. SETTING: Department of Obstetrics and Gynecology, Thammasat Hospital, Faculty of Medicine, Thammasat University. MATERIAL AND METHOD: From January, 2001-December, 2001, 80 patients who underwent outpatient gynecological laparoscopy were randomly allocated into group A (n = 40) and group B (n = 40). The patients in group A received 2 capsules of ginger (1 capsule contain 0.5 g of ginger powder) 1 h before the procedure while the patients in group B received the placebo. The visual analogue nausea scores (VANS) and vomiting times were evaluated at 2, 4 and 24 hours after operation. RESULT: There was a significant difference in the incidence of the nausea between group A [12 (30%)] and group B [23 (57.50%)]. The VANS was lower in group A than in group B at 2 and 4 hours (p < 0.05). No difference of VANS at 24 hours was found in both groups. Incidence and frequency of vomiting in group A were lower than group B but there were not statistically different. CONCLUSION: From our data, ginger is effective in prevention of nausea after outpatient gynecological laparoscopy.

Administration, Oral↗
PubMed2003

[Nausea and vomiting].

Nausea and vomiting are the most distressing side effects reported by patients undergoing CDDP-based cancer chemotherapy. Dopamine receptor antagonists and corticosteroids are used as anti-emetics for chemotherapy induced nausea and vomiting. Recently, a highly selective 5-HT3 receptor antagonist are proved to demonstrate antiemetic activity. 5-HT3 receptor antagonists are developed such as Granisetron, Ondansetron, Ramosetron, Azasetron. For acute emesis, complete control of vomiting was achieved in 80% of patients receiving 5-HT3 receptor antagonists. Though, it is reported to be only 20% effective for the complete control of delayed emesis. Psychiatric medications sometimes play a prominent role in the control of persisting emesis, particularly anticipatory or conditioned nausea. Nausea and vomiting are well controlled using various anti-emetics considering patient's condition and chemotherapy schedule.

Antineoplastic Agents↗