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PubMed1986

Gastrointestinal myoelectric correlates of vomiting in the dog.

Prior to vomiting, two gastrointestinal contractile events occur in succession: a giant contraction that propagates retrograde from mid-small intestine to the antrum (RGC) and a series of phasic contractions that occur at all levels of the gastrointestinal tract. We quantitatively examined the gastrointestinal myoelectric events associated with vomiting and correlated them with the previously defined contractile events. Twelve dogs of either sex were implanted with electrical or contractile recording devices implanted on the stomach and small intestine. After an overnight fast, gut activity was recorded before and after apomorphine administration (2.5-15 micrograms/kg, iv). We found that the RGC was correlated with two successive electrical events: disruption of electrical control activity (ECA) cycling and a potential change occurring at the upstroke of the RGC. However, the initial myoelectric event associated with vomiting was ECA frequency slowing of the antrum and lower half of the small intestine. The post-RGC phasic contractions were associated with ECA-dependent response activity and occurred during the period of ECA frequency slowing. Atropine (100 micrograms/kg iv) blocked the RGC and its associated electrical events but not the slowing of ECA frequency. Supradiaphragmatic vagotomy eliminated all gastrointestinal contractile and myoelectric events but antral ECA frequency slowing. Spontaneous occurrences of the myoelectric correlates of vomiting were not different from those activated by apomorphine. These results suggest that ECA disruption may be important for retrograde propagation of the RGC. The function of ECA frequency slowing, however, remains unknown.

Animals↗
PubMed1989

Functional localization of specific receptors mediating gastrointestinal motor correlates of vomiting.

The gastrointestinal motor correlates of vomiting consist of two contractile events, 1) a giant retrogradely propagated contraction of the upper small intestine, the retrograde giant contraction (RGC) and 2) a series of post-RGC phasic contractions that occur primarily in the lower small intestine. The effects of cholinergic, dopaminergic, serotonergic, and opioid receptor antagonists and an opioid receptor agonist on vomiting and its gastrointestinal motor correlates initiated by apomorphine (APO), CuSO4, or cholecystokinin octapeptide (CCK-8) were determined in awake dogs. Atropine blocked the retrograde giant contraction only, and hexamethonium blocked all jejunoileal motor responses activated by APO, CuSO4, or CCK-8. Domperidone blocked all effects of APO only, whereas haloperidol, methysergide, 1-(1-naphthyl) piperazine, and fentanyl blocked or inhibited responses to both APO and CuSO4. None of the dopaminergic, serotonergic, or opioid receptor antagonists or the opioid receptor agonist affected the gastrointestinal motor responses to CCK-8. Cinanserin or Sch 23390 had no effect on any of the responses activated by APO, CuSO4, or CCK-8. These results suggested that D2 dopaminergic and 5-HT2 serotonergic receptors of the emetic central pattern generator mediate vomiting and its gastrointestinal motor correlates, whereas opioid receptors may mediate tonic inhibition of these responses. In addition, peripheral muscarinic or nicotinic cholinergic receptors but not peripheral 5-HT2, dopaminergic, or opioid receptors mediate the gastrointestinal motor correlates of vomiting.

Animals↗
PubMed1991

Behavior of upper cervical inspiratory propriospinal neurons during fictive vomiting.

1. The role of upper cervical inspiratory (UCI)-modulated neurons in respiratory muscle control during vomiting was examined by recording the impulse activity of these neurons during fictive vomiting in decerebrate, paralyzed cats. Fictive vomiting was identified by a characteristic series of bursts of coactivation of phrenic and abdominal muscle nerves, elicited either by electrical stimulation of supradiaphragmatic vagal nerve afferents or by emetic drugs, which would be expected to produce expulsion of gastric contents in nonparalyzed animals. 2. Data were recorded from 43 propriospinal UCI neurons, located in the C1-C3 spinal segments near the border of the intermediate gray matter and lateral funiculus, which were antidromically activated with floating pin electrodes placed in the ipsilateral lateral funiculus, usually at T1-T3. Some cells (9/21 tested) were also activated from the upper lumbar cord (L1). During respiration, most neurons (n = 40) had an augmenting discharge pattern during inspiration. In addition, more than one-half (55%) fired tonically during the remainder of the respiratory cycle. About 40% of UCI neurons showed variations in their firing pattern during the noninspiratory portion of respiration. These latter two properties of UCI neurons were not observed in dorsal and ventral respiratory group (DRG and VRG-, respectively) bulbospinal inspiratory (I) neurons previously recorded under similar conditions. 3. During fictive vomiting, the firing pattern of most UCI neurons fell into one of three main categories. More than one-half (53%) were active in phase with bursts of phrenic discharge and were thus classified as Active-type cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

[Prevention and control of chemotherapy-induced nausea and vomiting].

Nausea and vomiting are considered one of the most distressing side-effects of chemotherapy. Complete control of acute and delayed emesis improves quality of life and increases adherence to treatment. The frequency of nausea and vomiting depends primarily on the emetogenic potential of the chemotherapeutic agents used. With the standard antiemetic therapy (5HT-3 receptor antagonists in combination with dexamethasone) approximately 13% of patients receiving chemotherapy have vomiting in the acute phase and almost 50% in the delayed phase. A new group of antiemetic drugs, the neurokinin-1 receptor antagonists, in combination with standard therapy significantly improves emesis protection in the acute and in the delayed phase, although control of nausea is not so effective. Nowadays chemotherapy-induced emesis still occurs. Recent developments in antiemetic therapy and responsibility to achieve the best control of nausea and vomiting in patients receiving chemotherapy justified a review of this problem, which is frequently underestimated by physicians and nurses.

Antiemetics↗
PubMed2006

Adrenal insufficiency caused by bilateral adrenal metastases -- a rare treatable cause for recurrent nausea and vomiting in metastatic breast cancer.

BACKGROUND: Nausea and vomiting are common symptoms in patients with malignant disease. Several, sometimes rare causes have to be considered to decide the right treatment. CASE REPORT: We report of a patient suffering from advanced breast cancer and complaining of severe nausea and vomiting over several weeks without any successful treatment. Later on, she developed marked hyperpigmentation of the skin and hypo-osmolar dehydration. Adrenal enlargement was noted in an abdominal scan. The suspected diagnosis of primary adrenocortical insufficiency due to metastases was confirmed by laboratory tests. After replacement therapy with hydrocortisone and fludrocortisone, the general condition of the patient improved dramatically and the symptoms of nausea and vomiting disappeared completely. CONCLUSION: If a patient with advanced cancer presents with unexplained and protracted nausea, vomiting and weakness, particularly if accompanied by hyponatremia and normal potassium levels, adrenal insufficiency due to adrenal metastases should be considered.

Adrenal Gland Neoplasms↗
PubMed1983

Vestibular-induced vomiting after vestibulocerebellar lesions.

Vestibular stimulation, by means of sinusoidal electrical polarization of the labyrinths of decerebrate cats, can produce vomiting and related activity resembling that seen in motion sickness. The symptoms include panting, salivation, swallowing, and retching as well as vomiting. These symptoms can be produced in cats with lesions of the posterior cerebellar vermis. In contrast to a previous proposal by Wang and Chinn in 1956, we suggest that a transcerebellar pathway from the vestibular apparatus through the nodulus and uvula to the 'vomiting center' is not essential for vestibular-induced vomiting and, by analogy, for the occurrence of many symptoms of motion sickness.

Animals↗
PubMed1982

Postoperative vomiting in children.

A survey of the frequency of postoperative vomiting in children was conducted over a two-month period. Completed questionnaires were obtained for 1183 patients. The important findings were a lower incidence of vomiting in children under three years of age and a significantly increased incidence of vomiting in patients premedicated with paparveretum and hyoscine. This clinical review highlighted areas where improvements could be made, particularly in the management of patients who vomit frequently. It also provides information which can be used for setting up more detailed controlled studies.

Adolescent↗
PubMed1994

Ondansetron for prevention of postoperative nausea and vomiting following minor oral surgery: a double-blind randomized study.

The efficacy and safety of ondansetron in preventing postoperative nausea and vomiting following minor oral surgery was evaluated in a prospective randomized double-blind study. Of a total of seventy-seven patients, randomly 38 had 4 mg of ondansetron and 39 had normal saline as placebo intravenously immediately prior to induction of anaesthesia. A standard general anaesthetic with thiopentone, suxamethonium, fentanyl, nitrous oxide and isoflurane was employed. Postoperatively nausea was assessed verbally and on a visual analog scale at 1, 4 and 24 hours from the time of awakening. Episodes of vomiting were recorded. Eight patients (21.1%) in the ondansetron group compared to 19 (48.7%) in the placebo group had nausea (P < 0.05) and 1 (2.6%) in the ondansetron group compared with 9 (23.1%) in the placebo group vomited (P < 0.05). Patients who vomited twice or more and the number who required a rescue antiemetic were significantly fewer in the ondansetron group (P < 0.05). Cardiovascular parameters were stable and showed no significant difference in the two groups. There were no significant adverse effects that could be directly attributable to ondansetron.

Adolescent↗
PubMed1998

Lack of efficacy of propofol in the treatment of early postoperative nausea and vomiting.

The anti-nauseant efficacy of low-dose propofol was investigated in a blinded, randomized trial. Patients who complained of nausea and/or vomiting following laparoscopic gynaecological surgery and who requested antiemetic were randomly assigned to receive placebo, propofol 3 mg, propofol 9 mg or propofol 27 mg by intravenous injection. Nausea, vomiting and sedation were recorded by a blinded observer for 90 minutes following administration of the test drug, prior to discharge, and 24 hours following surgery. Rescue antiemetic (droperidol 1.0 mg i.v.) was available from 10 minutes after administration of test drug. Propofol failed to reduce nausea scores and did not reduce the incidence of vomiting. Numbers of patients receiving rescue antiemetic were similar in the four treatment groups. In the first 10 minutes following test drug administration, sedation scores were increased by propofol in a dose-related manner. We conclude that, in the dose range studied, propofol is ineffective for the treatment of nausea and vomiting occurring soon after laparoscopic gynaecological surgery.

Adult↗
PubMed1995

Was late-nineteenth-century nervous vomiting an early variant of bulimia nervosa?

We studied a wide variety of medical publications to find out whether late-nineteenth-century nervous or hysterial vomiting was clinically consistent with modern bulima nervosa. Since modern diagnostic criteria of bulimia nervosa my be time- and culture-bound, we made use of adapted criteria, focusing on the more overt, physical and behavioural features of the syndrome. In retrospect, it became obvious that only some of these specific diagnostic requirements were met. Indeed, late-nineteenth-century nervous or hysterical vomiters most likely have been non-organically-ill neurotics. However, their disorder was more closely associated with food abstinence in general and anorexia nervosa in particular than with overeating. Only in a few cases doctors made mention of recurrent episodes of binge eating, but there was no convincing evidence of any concern for body shape and weight. Obviously, late-nineteenth-century nervous or hysterial vomiting was still located at the crossing between classic hysteria, the 'new' clinical entity of anorexia nervosa, and forms of psychogenic vomiting.

Anorexia Nervosa↗
PubMed1986

Nausea and vomiting possibly associated with intravenous acyclovir.

Nausea and vomiting have not been clearly associated with parenteral acyclovir. We report a pediatric patient who developed nausea and vomiting apparently associated with intravenous acyclovir therapy. The child received acyclovir (1500 mg/m2/d) for treatment of recurrent varicella zoster with possible dissemination. Nausea and vomiting could be attributed only to acyclovir therapy. Discontinuing the drug resulted in a resolution of the adverse symptoms. Adverse effects of parenteral acyclovir can mimic the early manifestations of Reye's syndrome, which is an important consideration in children with viral infections. It is necessary to distinguish the cause of nausea and vomiting for proper management of patients.

Acyclovir↗
PubMed1999

Systematic review of ondansetron for the prevention and treatment of postoperative nausea and vomiting in adults.

OBJECTIVES: To determine the efficacy and safety of ondansetron for the prevention and treatment of postoperative nausea and vomiting (PONV) in adults. DESIGN: Systematic review of published double-blind randomised controlled trials. DATA SOURCES: Twenty seven trials from 1990 to July 1998 retrieved from a systematic literature search (Medline, Cinahl, Embase, Cochrane Library, reference lists, hand searching of anaesthetic journals, & provided manufacturer information); restricted to English language. MAIN OUTCOME MEASURES: Estimation of efficacy (incidence of complete absence of nausea or other outcome measure as defined by the authors) at 24 hours. RESULTS: Seven double-blind randomised controlled trials with 1,623 patients studied intravenous ondansetron 1 mg, 4 mg, or 8 mg for the treatment of postoperative nausea and vomiting (PONV). Four mg, compared with metoclopramide 10 mg, produced higher patient satisfaction scores and an increased incidence of freedom from nausea at 24 hours. Further studies are required to compare the safety, efficacy and dose response with other anti-emetics at 24 hours. Twenty double-blind randomised controlled trials with 4,364 patients studied intravenous and oral administration of ondansetron 1 mg, 4 mg, and 8 mg for the prevention of postoperative nausea and vomiting. There appears to be no significant difference between droperidol (0.625 mg, 1 mg or 1.25 mg) i.v. and ondansetron 4 mg in efficacy and incidence of side effects. Compared with metoclopramide, ondansetron produced less nausea but the incidence of vomiting was the same at 24 hours. CONCLUSIONS: Further PONV could be prevented with ondansetron 4 mg compared with placebo and metoclopramide 10 mg. Further studies are required to compare ondansetron with other anti-emetics for the treatment of PONV. For prophylaxis of PONV ondansetron 4 mg appears to be equal to low dose droperidol in efficacy and the incidence of side effects, and superior to metoclopramide. Ondansetron should perhaps be limited to second line treatment in view of patient satisfaction, efficacy and cost when compared with droperidol.

Adult↗
PubMed1996

Single 8 mg dose of oral ondansetron failed to prevent FAC chemotherapy-induced acute nausea and vomiting.

The aim of this open, nonrandomized, monocentric study was to evaluate the efficacy of a single daily dose of 8 mg oral ondansetron in the prophylaxis of acute nausea and vomiting in chemotherapy-naive breast cancer patients receiving their first cycle of chemotherapy with 5-fluorouracil, doxorubicin and cyclophosphamide (FAC). Forty-five female patients were recruited, median age 42 years. The number of emetic episodes and the grade of nausea were recorded. 51% of patients achieved complete, and 9% major control of acute emesis. 33% of patients experienced no acute nausea, and in 18% nausea was mild. Complete protection from nausea and vomiting (complete prophylaxis) was obtained in 12/45 (27%) of patients. Treatment success (no vomiting with no more than mild nausea) was achieved in 18/45 (40%) of patients. We conclude that the efficacy of a single dose of 8 mg oral ondansetron in controlling acute nausea and vomiting induced by FAC chemotherapy is not high enough to justify its use as a sole antiemetic agent in outpatients.

Acute Disease↗
PubMed2006

Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis.

OBJECTIVE: To report the incidence of postoperative nausea and vomiting (PONV), to describe the use of anti-emetics both for the prophylaxis and treatment of PONV, and to assess resource utilization and duration of post-anesthesia care unit (PACU) stay. RESEARCH DESIGN AND METHODS: We retrieved data from the Duke Anesthesia Peri-operative database. We included adult patients, who underwent inpatient surgery under general anesthesia with inhaled agents between January 2004 and February 2005, and had two or more risk factors for PONV documented preoperatively (female, previous history of PONV or motion sickness, non-smoker or use of postoperative opioid). Data on the use of prophylactic anti-emetics, the incidence of PONV, nausea scores, pain scores, and the use of rescue anti-emetics in PACU and in the period between PACU discharge and 24 h after surgery were recorded. Resource utilization and cost assessment was performed from the perspective of the hospital and included length and direct cost of PACU stay, as well as the acquisition costs of rescue anti-emetics in PACU. Descriptive statistics were used to summarize the demographic characteristics of patients. For group comparisons, data were analyzed with the t-test for continuous data, and the Chi-square test for categorical data. Multiple linear regression models were used to evaluate the association between PONV and PACU length of stay adjusting for confounding factors. RESULTS: A total of 3641 patients were included in the analysis. Of those, 2869 (79%) received prophylactic anti-emetics. In the PACU, nausea and vomiting were reported in 16% and 3% of the patients, respectively. Rescue anti-emetics were given to 26% of all patients. The incidence of vomiting was significantly less in patients who received PONV prophylaxis (p = 0.03). In multiple linear regression models, the duration of PACU stay was longer by a mean of 25 min in patients who experienced PONV or received rescue anti-emetics in PACU (p < 0.0001) despite the fact that the duration of surgery was shorter by a mean of 24 min in this group of patients (p < 0.0001). Following PACU discharge, 40% of patients reported nausea, vomiting or needed rescue anti-emetics. PONV was associated with significantly increased resource utilization and costs of PACU stay (p < 0.0001). Emesis was associated with greater incremental cost (138 US dollars) than nausea (85 US dollars), mainly from the longer duration of PACU stay. CONCLUSIONS: PONV remain a significant problem postoperatively and often persists beyond PACU discharge. The presence of PONV is associated with increased length of PACU stay and greater resource utilization and costs.

Adult↗
PubMed1989

Controlling delayed vomiting: double-blind, randomized trial comparing placebo, dexamethasone alone, and metoclopramide plus dexamethasone in patients receiving cisplatin.

The majority of patients receiving cisplatin at a dose of 120 mg/m2 experience delayed nausea and vomiting occurring between 24 and 120 hours after chemotherapy administration. Ninety-one patients who were receiving cisplatin (120 mg/m2) as initial chemotherapy were entered into this double-blind trial. All patients received intravenous (IV) metoclopramide, dexamethasone, and lorazepam for the control of acute emesis during the period from 0 to 24 hours after cisplatin. Patients were then randomized to one of three treatment regimens: placebo; oral dexamethasone, 8 mg twice daily for two days, then 4 mg twice daily for two days; or the combination of oral metoclopramide, 0.5 mg/kg four times daily for four days, plus oral dexamethasone administered as above. Forty-eight percent of individuals who received the two-drug combination of metoclopramide plus dexamethasone experienced delayed vomiting as opposed to 65% who were administered dexamethasone alone and 89% who received placebo (P = .006). Scores assessing the severity of delayed nausea and vomiting were consistently worse in individuals receiving placebo. The incidences of sleepiness, restlessness, heartburn, hiccoughs, loose bowel movements, insomnia, and acute dystonic reactions did not differ significantly among the three regimens and were mild and self-limited. The two-drug combination of oral metoclopramide plus dexamethasone is well tolerated, safe, and more effective than dexamethasone alone or placebo in controlling delayed vomiting following cisplatin.

Adult↗
PubMed1992

Metoclopramide reduces the incidence of vomiting after tonsillectomy in children.

The efficacy of intravenous metoclopramide in controlling vomiting in children after tonsillectomy was determined in a prospective randomized, double-blind investigation. One hundred two unpremedicated, ASA physical status I or II children between the ages of 1 and 15 yr who were undergoing surgical removal of the tonsils, with or without adenoidectomy, were studied. Anesthesia was induced either with halothane, nitrous oxide, and oxygen by mask or by intravenous thiopental and was maintained with halothane, nitrous oxide, oxygen, and intravenous morphine (0.1 mg/kg). Each child randomly received either 0.15 mg/kg of metoclopramide or saline solution placebo intravenously after transfer to the postanesthesia care unit. All episodes of vomiting were recorded for 24 h after completion of surgery. The incidence of vomiting in the saline solution group was 70%, compared with 47% in the metoclopramide group (P = 0.026). The authors conclude that the administration of intravenous metoclopramide in a dose of 0.15 mg/kg on arrival in the postanesthesia care unit significantly decreases the incidence of vomiting in children after tonsillectomy.

Adolescent↗
PubMed1993

Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy.

The possible postoperative antiemetic effect of transcutaneous electrical nerve stimulation (TENS) on the P6 point (on the Pericardium Channel of Hand-Jueyin) was evaluated in 103 women undergoing hysterectomy. TENS on the P6 point was applied 30-45 min before induction of anesthesia in 51 patients and continued for 6 h postoperatively. The control group, 52 patients, was treated exactly in the same way but with the electrical stimulator turned off. Incidence of vomiting was assessed blindly 2 h, 4 h, 6 h, and 8 h postoperatively. The incidence of vomiting postoperatively was significantly less in the TENS-treated group when compared with the control group (between 0 h and 2 h: 23% vs 43%, P < 0.05; between 2 h and 4 h: 27% vs 50%, P < 0.025; and between 4 h and 6 h: 31% vs 67%, P < 0.001, respectively). Six hours postoperatively TENS was discontinued, and 8 h postoperatively the two groups did not differ significantly for incidence of vomiting (between 6 h and 8 h: 51% vs 65%). The authors conclude that TENS reduces the incidence of vomiting after hysterectomy.

Adult↗
PubMed1994

Ondansetron reduces the incidence and severity of poststrabismus repair vomiting in children.

This prospective, randomized, placebo-controlled, double-blinded study evaluated the antiemetic efficacy of ondansetron and metoclopramide in 90 ASA physical status I or II children, 2-17 yr of age, undergoing strabismus repair. After anesthetic induction and prior to eye muscle manipulation, subjects received normal saline 0.3 mL/kg (Group 1), metoclopramide 0.25 mg/kg (Group 2), or ondansetron 0.15 mg/kg (Group 3), intravenously. There were no differences between groups with respect to age, weight, gender, fluids received, number of eye muscles repaired, anesthetic technique, or time in the operating room. The incidence of vomiting in Groups 1, 2, and 3 was 50%, 27%, and 10% prior to discharge, and 67%, 53%, and 30% during the 24 h after surgery, respectively. The number of children vomiting prior to discharge and within 24 h of surgery was significantly reduced in Group 3 compared with Group 1 (P < 0.003 and P < 0.015, respectively). The number of vomiting episodes per patient in Groups 1, 2, and 3 was 1.1, 0.5, and 0.1 prior to discharge, and 4.5, 2.6, and 1.2 during the 24 h after surgery (P < 0.0005 and P < 0.004, respectively). Ondansetron 0.15 mg/kg intravenously after the induction of anesthesia reduces the incidence and severity of vomiting after strabismus repair both prior to discharge from the hospital and during the 24 h after surgery.

Adolescent↗