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At least 649 records · Page 36Linked to original sources
PubMed2002

P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children.

BACKGROUND: P6 acupuncture in adults is reported to be an effective preventive treatment for postoperative nausea and vomiting (PONV). It is not clear, however, whether this technique is effective as a preventive treatment for PONV in children. METHODS: Children undergoing anesthesia and surgery were randomized to four groups: (a) intravenous saline + bilateral P6 acupoint injections (n = 50); (b) intravenous droperidol + bilateral P6 sham acupuncture (n = 49); (c) intravenous saline + bilateral sham point injections (n = 43); (d) intravenous saline +bilateral P6 sham acupuncture (n = 45). The perioperative anesthetic technique was standardized in all subjects. The incidence of postoperative nausea and vomiting (PONV) was evaluated in postanesthesia care unit (PACU) and 24 h after surgery. RESULTS: Incidence of nausea in the PACU was significantly lower in the acupoint group as compared with the sham point group (32% vs. 56%, P = 0.029) and P6 sham group (32% vs. 64%, P = 0.002) but not as compared with the droperidol group (32% vs. 46%, P = ns). Similarly, subjects in the acupoint group had a significantly lower incidence of vomiting in the PACU as compared with the sham point group (12% vs. 33%, P = 0.026) and P6 sham group (12% vs. 31%, P = 0.029) but not as compared with the droperidol group (12% vs. 18%, P = ns). The combined incidence of early PONV was also lower in the acupoint group as compared with the sham point group (P = 0.045) and P6 sham group (P = 0.004) but not as compared with the droperidol group (42% vs. 51%, P = ns). Finally, significantly fewer subjects in the acupoint group required intravenous ondansetron as an initial rescue therapy (P = 0.024). At 24 h after surgery, however, the incidence of late PONV was similar among the four study groups (P = ns). CONCLUSION: In children, P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting.

Acupuncture↗
PubMed2005

Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron.

BACKGROUND: At dosages above 0.1 mg/kg, droperidol induces a dose-dependent QTc interval prolongation. Although subject to controversy, low-dose droperidol has recently been suspected to induce cardiac arrhythmias. Hence, 5-hydroxytryptamine type 3 antagonists have become the first-line drug for management of postoperative nausea and vomiting. These drugs are also known to prolong the QTc interval at high dosages. This study describes QTc interval changes associated with postoperative nausea and vomiting treatment by droperidol or ondansetron at low doses. METHODS: Eighty-five patients with postoperative nausea and vomiting were included in this prospective, single-blind study. Patients received either 0.75 mg intravenous droperidol (n = 43) or 4 mg intravenous ondansetron (n = 42). Electrocardiographic recordings were obtained before administration of antiemetic drug and then 1, 2, 3, 5, 10, and 15 min after. Electrocardiographic monitoring was maintained for 3 h in eight patients in each group. RESULTS: The QTc interval was prolonged (> 450 ms in men, > 470 ms in women) in 21% of the patients before antiemetic drug administration. This was significantly correlated with lower body temperature and longer duration of anesthesia. Compared with predrug QTc measurement, both antiemetics were associated with a significant QTc interval prolongation (P < 0.0001). The mean maximal QTc interval prolongation was 17 +/- 9 ms after droperidol occurring at the second minute and 20 +/- 13 ms after ondansetron at the third minute (both P < 0.0001). Compared with predrug measurement, the QTc interval was significantly lower after the 90th minute in both groups. CONCLUSIONS: Droperidol and ondansetron induced similar clinically relevant QTc interval prolongations. When used in treatment of postoperative nausea and vomiting, a situation where prolongation of the QTc interval seems to occur, the safety of 5-hydroxytryptamine type 3 antagonists may not be superior to that of low-dose droperidol.

Adult↗
PubMed1997

Descending pathway from the central pattern generator of vomiting.

The central pattern generator (CPG) for vomiting has been postulated to consist of non-respiratory neurons in the reticular area dorsomedial to the retrofacial nucleus. CPG neurons are known to produce vomiting activity patterns similar to respiratory spinal motoneurons and premotoneurons in the caudal part of the ventral respiratory group (cVRG). This study was performed to reveal direct connections between CPG neurons and cVRG neurons in dogs. Twenty-seven non-respiratory neurons were identified as CPG neurons based on their responses to vagal stimulation and their firing patterns of vomiting. Nine of these 27 neurons antidromically responded to cVRG stimulation. These results suggest that the CPG directly drives respiratory premotor neurons in the cVRG to produce vomiting motions.

Abdominal Muscles↗
PubMed1995

Control of nausea and vomiting by Navoban (tropisetron) in 131 children receiving cytotoxic chemotherapy.

One hundred and thirty-one children with a median age of 5 years were administered Navoban (tropisetron), a selective antagonist of the serotonin receptor (5-HT3), dosed once daily at 0.2 mg/kg (with a maximum of 5 mg daily) in a study aimed at evaluating the prevention of nausea and vomiting induced by anti-cancer chemotherapy. The most common malignancy (in 49% of patients) was acute lymphocytic leukaemia. Patients received Navoban during one or more courses of emetogenic chemotherapy for a total of 455 courses administered intravenously or intravenously and intrathecally (IV + IT). Most patients (89%) had already received cytotoxic chemotherapy before enrollment for the trial. On Day 1, Navoban was administered slowly and intravenously as a single dose before the start of chemotherapy, or by mouth as a single daily dose on subsequent days (median treatment duration = 5 days). On the first 5 days of each course of chemotherapy, response to Navoban per 24-hour period was graded as: complete (absence of both nausea and vomiting), partial (1-4 vomits and/or less than 5 hours of nausea), or failure (more than 4 vomits and/or at least 5 hours of nausea). Ninety-six per cent of the intravenous chemotherapy group and 97% of the IV + IT chemotherapy group had a complete (70% and 55% respectively) or partial (26% and 42% respectively) response during the first 24-hour period of the first course in which Navoban was used. The second and subsequent courses yielded similar percentages. Delayed emesis was observed mainly during those courses employing the most emetogenic chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients.

The purpose of this study was to examine the effectiveness of progressive muscle relaxation (PMR) in reducing the nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Subjects comprised 60 cancer chemotherapy patients who were hospitalized in a cancer center. These subjects were randomly assigned to either the experimental or control group. In addition to routine nursing care, subjects in the experimental received PMR training, while those in the control received contact with the investigator. Results from this study verified the effectiveness of PMR in reducing total scores used to measure nausea, vomiting, and retching; subscale scores of nausea; and subjective feelings of anxiety. The efficacy of PMR to reduce subscale scores of vomiting was not verified, partly due to an extremely low incidence of vomiting.

Adult↗
PubMed1983

Behavioral treatment of psychogenic vomiting in the context of social phobia.

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patient's behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patient's records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patient's personal, social, and vocational life has also occurred.

Adult↗
PubMed1995

Psychophysiologic treatment of cyclic vomiting.

Cyclic vomiting (CV) presents a crisis not only to the identified patient but also to the entire family, who often feel like helpless victims of the effects of the vomiting cycles. This often creates despair, depression, and anger about the vomiting continuing indefinitely. If the child can be given effective medication and the family can be helped with the emotional burden surrounding the illness, the frequency and severity of CV tends to diminish. This article explores ways of lessening the psychologic and social effects of the cyclical vomiting through a multidisciplinary treatment plan for the family that involves the pediatrician, school, psychotherapist, and family as effective therapeutic agents. The child needs to be helped to express feelings which he or she cannot put into words. The article describes dramatic play involving symbolization of the illness, creation of metaphors in stories and drawings for the dilemmas surrounding CV and family therapy in which unnamed stresses are given consideration. Through this treatment, health and hope are promoted within each family member.

Adolescent↗
PubMed1995

Treatment of cyclic vomiting in childhood with erythromycin.

Cyclic vomiting syndrome (CVS) is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 24 children (10 boys, 14 girls). Many patients had mild associated abdominal pain with their vomiting. Fourteen patients had previously been given metoclopramide but none responded. Two patients were mildly developmentally delayed. Twenty-four patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/day, in two to four divided doses for 7 days. This dose was repeated as needed when symptoms reappeared. Eighteen of 24 patients reported total resolution of symptoms when re-evaluated at 2 and 6 months. All males responded, eight of 18 responders were female, and all six with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of CVS in childhood. Because the study was uncontrolled, placebo effect cannot be excluded. Case-controlled, double-blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in CVS.

Adolescent↗
PubMed1998

Hypocaloric oral therapy during an episode of diarrhea and vomiting can lead to severe malnutrition.

BACKGROUND: Malnutrition associated with diarrhea and vomiting can be prevented if the focus of treatment is on nutritional requirements. Some pediatricians inappropriately continue to recommend clear liquids followed by dilute feedings or hypocaloric diets until the diarrhea clears. METHODS: Medical records were retrospectively reviewed, and the literature was reviewed. RESULTS: Severe malnutrition occurred in two children with diarrhea and vomiting who were treated with clear liquids followed by restricted nutrient intake. CONCLUSION: Severe malnutrition associated with diarrhea and vomiting can occur when the prescribed treatment is bowel rest followed by hypocaloric diets until diarrhea clears. Malnutrition can be prevented if the focus of treatment is on nutritional requirements. Current American Academy of Pediatrics recommendations for treatment of diarrhea and vomiting are discussed.

Child, Preschool↗
PubMedDate not supplied

Isopropyl alcohol inhalation: alternative treatment of postoperative nausea and vomiting.

BACKGROUND: The mechanisms for postoperative nausea and vomiting are numerous and pathways not well elucidated. Although many medications have been developed to help prevent postoperative nausea and vomiting, the search for better approaches to recovery treatment continues. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of isopropyl alcohol (IPA) inhalation for treatment of postoperative nausea and vomiting for patients who have general anesthesia for a surgical procedure. METHOD: Participants were recruited from an urban hospital on the East Coast of the United States. Participants were assigned to an experimental or control group and IPA inhalation was compared to the standard anti-emetic treatment for rescue treatment in the immediate postoperative period. Postoperative nausea and vomiting was rated using a descriptive ordinal scale. RESULTS: The results of this study show IPA to be effective and that there was no significant difference between the standard treatment protocol and treatment with IPA. Treatment with IPA was significantly more cost effective than standard drug treatment. DISCUSSION: Further research is recommended to evaluate the length of effectiveness, standard dose needed, most effective mode of inhalation, and factors blocking IPA effectiveness.

2-Propanol↗
PubMed1994

Ondansetron and metoclopramide fail to prevent vomiting secondary to ultra-high-dose cisplatin-carboplatin chemotherapy.

OBJECTIVE: To determine the severity of emesis caused by ultra-high-dose cisplatin-carboplatin chemotherapy and to compare the antiemetic efficacy of an ondansetron regimen and a metoclopramide regimen. METHODS: Forty consecutive patients with stage III or IV epithelial ovarian cancer or advanced or recurrent endometrial cancer were treated with ultra-high-dose cisplatin-carboplatin chemotherapy. No patient had received prior chemotherapy. Chemotherapy consisted of intravenous (IV) cisplatin 70 mg/m2 and IV carboplatin 100 mg/m2 administered on days 1 and 8 every 28 days for five cycles, representing a total monthly organoplatin dose of 207 mg/m2. Patients were randomized to receive metoclopramide, diphenhydramine, prochlorperazine, and lorazepam; or ondansetron, dexamethasone, prochlorperazine, and lorazepam. Patients were blinded and there was no crossover. The metoclopramide dose was 2 mg/kg IV every 2 hours x 3, and the ondansetron dose was 0.15 mg/kg IV every 4 hours x 3. RESULTS: All 40 patients developed vomiting; 21 (52%) developed severe vomiting and seven (17%) required home IV therapy (grade 4). Eight patients (40%) receiving the metoclopramide regimen developed severe vomiting, compared to 13 (65%) in the ondansetron group (P = .50). Two patients (10%) in the metoclopramide group developed grade 4 vomiting, compared to five (25%) in the ondansetron group (P = .45). Except for sedation and amnesia, there were no significant side effects associated with either regimen. CONCLUSION: Neither regimen was effective in preventing high-dose cisplatin-carboplatin-induced emesis, and the ondansetron regimen did not appear to be superior.

Aged↗
PubMedDate not supplied

Prevention and management of postoperative nausea and vomiting.

PURPOSE: To identify factors associated with the occurrence of postoperative nausea and vomiting and to identify the effectiveness of independent and interdependent nursing interventions for the prevention and management of postoperative nausea and vomiting. DESIGN: Descriptive. SAMPLE: A convenience sample of 300 patients, 18 years or older, who had surgery with general anesthesia (excluding persons having ear or gastrointestinal surgery), at either campus of a large metropolitan medical center. METHOD: A combination of closed chart review and data collection by staff nurses assigned to the patients in the postoperative period using a standardized data collection tool. FINDINGS: Data was analyzed using a combination of descriptive and parametric statistics. There was a 39% incidence of nausea and vomiting overall. Women were two times more likely to experience nausea and twice as likely to experience severe nausea (statistical significance of p = .0001). In addition, persons with surgery lasting 2 hours or greater were twice as likely to experience nausea (statistical significance of p = .002). Independent nursing interventions, such as placing a cool washcloth on a patient's forehead, were used more often than medication as an initial strategy. The most frequently used interventions were increasing the i.v. fluids and having the patient take deep breaths. There was no pattern to the nursing assessments. CONCLUSION: Women and those patients with surgery lasting greater than 2 hours should be assessed for nausea in the postoperative period more frequently. Assessments need to be done during the first 2 hours after surgery, at 7-8 hours after surgery, and when there is an increase in activity, such as the first time out of bed. Nurses do not routinely document assessments for postoperative nausea. In addition, some misconceptions exist. Formal and informal education for nurses, physicians, and patients on the incidence, predisposing factors, and treatment options for postoperative nausea needs to occur. This should include reflection on the misconceptions, the need for ongoing patient assessment, and a review of drug and nondrug therapies. IMPLICATIONS FOR NURSING RESEARCH: Further research is needed to better describe the present practice patterns in the treatment of postoperative nausea and vomiting, including a comparison of inpatient and outpatient settings. The relative effectiveness of specific nursing interventions should be measured, such as i.v. fluids, deep breathing, and antiemetic use. In addition, the evaluation of the effectiveness of the use of a research protocol would be useful.

Adolescent↗
PubMedDate not supplied

Retrospective exaggeration of symptoms: vomiting after gastric surgery for obesity.

The possibility that patients may retrospectively exaggerate the severity of complaints that they have experienced has not been systematically investigated. The validity of retrospective reports was called into question by a study of vomiting following gastric bypass surgery for obesity. Such vomiting occurred relatively infrequently--no more than 3.4 times per week, even during the first postoperative month. At a 6-month follow-up, however, some patients reported that they had experienced very high rates of vomiting postoperatively, in direct contradiction to their earlier reports. Such retrospective exaggeration has apparently contributed to the widespread belief that vomiting following gastric bypass surgery is a serious problem. We believe that this report is the first to describe retrospective exaggeration of symptoms. Further research is needed to assess the extent of this problem.

Adult↗
PubMed2002

A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy.

Ondansetron was compared with placebo for nausea and vomiting prophylaxis after fentanyl/isoflurane/relaxant anesthesia and infratentorial craniotomy. Eight milligrams intravenous ondansetron or vehicle was administered at skin closure. Nausea, emesis, and antiemetic use were recorded at 0, 0.5, 1, 4, 8, 12, 24, and 48 hours. There were no significant intergroup differences for nausea incidence at any interval, but cumulatively the placebo group was 3.2 times more likely to develop nausea during the first 12 hours (P = .04). Nausea incidence was bimodal in both groups, peaking during the first 1 to 4 hours. A nadir occurred at 8 to 12 hours, but nausea increased during the next 36 hours. By 48 hours, approximately 40% of patients in both groups were still nauseated. Reduced vomiting frequency was seen with ondansetron at 4, 8, 12, and 24 hours (P < .05). Despite rescue antiemetics, emesis occurred in an irregular pattern with episodes still observed in 35% of placebo patients at 48 hours. For ondansetron, emesis was infrequent for the first 12 hours but then a persistent increase was observed (48 hours, 22%). The incidence of rescue antiemetic use was 65% for both groups. There was no effect of gender. Nausea and vomiting are frequent and protracted after infratentorial craniotomy. Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.

Adolescent↗
PubMed2003

Transcutaneous acupoint electrical stimulation in preventing and treating nausea and vomiting in patients receiving electroconvulsive therapy.

A significant number of patients complain of nausea after general anesthesia and electroconvulsive therapy (ECT). Nausea is second only to headache as the most frequent and troublesome systemic side effect of ECT. The most common treatment of this is antiemetic drugs. Transcutaneous acupoint electrical stimulation (TAES) is a nonpharmacologic method for preventing and treating nausea and vomiting. TAES can alleviate motion sickness, reduce the incidence of vomiting caused by chemotherapy, and treat pregnancy-induced nausea and vomiting. TAES has been shown to reduce the incidence of postoperative nausea after general anesthesia. This is the first report to review the effectiveness of TAES in preventing and treating nausea and vomiting in 11 patients receiving ECT. Nine of these patients had a good response to TAES. One patient had a mixed response, and 1 did not respond to TAES.

Acupuncture↗
PubMed2006

Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting.

PURPOSE OF REVIEW: The use of selective 5-hydroxytryptamine type 3 receptor antagonists has improved the management of postoperative nausea and vomiting, but has not completely eliminated it. In this article, we discuss the pharmacology of 5-hydroxytryptamine type 3 receptor antagonists and the impact of pharmacogenetics on postoperative nausea and vomiting. RECENT FINDINGS: Dolasetron, granisetron, ondansetron, palonosetron, and tropisetron have similar mechanisms of action but different pharmacokinetic and pharmacodynamic properties. Genetic polymorphism in the cytochrome P450 mono-oxygenase system, drug efflux transporter adenosine triphosphate-binding cassette subfamily B member 1 and 5-hydroxytryptamine type 3 receptor subunits also contribute to the interindividual variation in response to different 5-hydroxytryptamine type 3 receptor antagonists. These differences account for differences in the duration of action and clinical efficacy of these agents. SUMMARY: Pharmacogenetics testing in patients may help differentiate responders to 5-hydroxytryptamine type 3 receptor antagonists from non-responders and allow the anesthesiologist to individualize antiemetic therapy. The cost-effectiveness of such screening in postoperative nausea and vomiting management has, however, not been evaluated. Given the multifactorial nature of postoperative nausea and vomiting, a multimodal approach to reduce or eliminate risk factors will be most successful in its management.

ATP Binding Cassette Transporter, Subfamily B↗
PubMed2004

A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy.

OBJECTIVES: To estimate whether the use of ginger to treat nausea or vomiting in pregnancy is equivalent to pyridoxine hydrochloride (vitamin B6). METHODS: A randomized, controlled equivalence trial involving 291 women less than 16 weeks pregnant was undertaken at a teaching hospital in Australia. Women took 1.05 g of ginger or 75 mg of vitamin B6 daily for 3 weeks. Differences from baseline in nausea and vomiting scores were estimated for both groups at days 7, 14, and 21. RESULTS: Ginger was equivalent to vitamin B6 in reducing nausea (mean difference 0.2, 90% confidence interval [CI] -0.3, 0.8), retching (mean difference 0.3; 90% CI -0.0, 0.6) and vomiting (mean difference 0.5; 90% CI 0.0, 0.9), averaged over time, with no evidence of different effects at the 3 time points. CONCLUSION: For women looking for relief from their nausea, dry retching, and vomiting, the use of ginger in early pregnancy will reduce their symptoms to an equivalent extent as vitamin B6. LEVEL OF EVIDENCE: I

Adult↗
PubMed2006

Changes in internal states across the binge-vomit cycle in bulimia nervosa.

While there is considerable evidence that bulimic behaviors serve the function of modifying internal states (e.g., satiety, mood), there is less clarity over the roles of the different behaviors across the binge-purge cycle. The present study examines the impact of bingeing and vomiting upon these internal states at different time points, and evaluates the potential reinforcement of those behaviors by the changes in internal states. Twenty-three women with diagnoses of bulimia nervosa completed a diary of all binge-vomit episodes over the course of 7 days, rating their internal states (satiety, negative mood, positive mood) at four time points during each episode. There were substantial changes across the cycle in levels of hunger, fullness, guilt/shame, anxiety/worry, and happiness/relief, but not in other states. The changes indicate that the binge-vomit cycle is maintained by the effects of both behaviors, but that the vomiting behavior evokes the strongest pattern of reinforcement. Further research is needed to determine the levels of internal states during the binge itself.

Adult↗