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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

[Postoperative vomiting].

INTRODUCTION: Nausea and vomiting following general anaesthesia are among the most frequent adverse reactions causing complications, the relief of which is an absolute demand. 5-HT3 receptor antagonists, such as ondansetron, belonging to the latest class of antiemetics were launched more than a decade ago. PATIENTS/METHODS: Efficacy and tolerability of ondansetron injection in prevention of postoperative nausea and vomiting were investigated in a prospective, randomised, double-blind, placebo controlled, three-armed clinical study in 148 patients undergoing laparoscopic cholecystectomy. Moreover the authors also investigated the effect of timing of dosing, i.e. whether the administration of antiemetic drug before starting anaesthesia has any advantage comparing its use at the end of operation. RESULTS: While using a standard surgical and anaesthesia method vomiting after laparoscopic cholecystectomy occurred in a frequency of 44.7% of the patients in the placebo group, whereas the figures decreased significantly after administration of 4 mg ondansetron at the end (28.9%) or before (25.5%) anaesthesia. Inclusively the frequency of severe cases decreased from 19.2% of control group up to 8.9% and 4.3% in the active groups, respectively. CONCLUSIONS: Intravenous administration of 4 mg ondansetron effectively reduces vomiting occurring in more than 40% of patients after laparoscopic cholecystectomy, especially the frequency of severe cases, and mainly if administered before operation. The preparation is safe; no clinical or laboratory adverse reactions, complications have been observed in the studied patients.

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↗
PubMed2002

Cyclic vomiting syndrome in Thai children.

Cyclic vomiting syndrome (CVS) is a severe childhood vomiting disorder of unknown etiology and pathogenesis. Clinical manifestations and prophylactic therapy of vomiting have been described in the literature. The data were limited in Asian children. The aim of this study was to study the clinical manifestation, to evaluate using antimigraine prophylactic drugs and response in Thai children with CVS. The medical records of children with a diagnosis of CVS in the Department of Pediatrics, Siriraj Hospital, Mahidol University from 1994 to 2001 were retrospectively reviewed. Demographic data, clinical manifestations, investigations, treatment and outcome were collected and analyzed. Twenty five patients were enrolled in this study including 13 females and 12 males. Their ages ranged from 2.3 years to 14 years (7.8 +/- 3.4 years). The age of onset was 5.2 +/- 3.2 years. They had 14.7 +/- 6.5 episodes per year with a duration of each attack 4 +/- 1.8 days. There were 8 mild, 10 moderate and 7 severe cases. There were only 6 patients (24%) who had headache and 50 per cent of these had a family history of migraine. Eight patients received pizotifen which had 3 good, 1 fair, and 4 poor responses. Of this group, in 3 patients pizotifen was changed to amitriptyline. Eighteen patients received amitriptyline and the result of treatments were 11 good, 4 fair, and 3 poor. The other 2 patients were on propranolol with one good and one poor responses. The efficacy of amitriptyline and pizotifen were compared (83.3% vs 50%) which revealed no statistical significance (p = 0.14). There was no side effect from any of the medication in this study. In conclusion, the present report showed similar data of clinical features, prophylactic treatment and outcome as previous reports, except for fewer migraine headaches in patients and their families. Amitriptyline and pizotifen were effective in prophylactic therapy of vomiting episodes.

Adolescent↗
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↗
PubMed2002

[Clinical observation of granisetron in preventing postoperative nausea and vomiting following supratentorial craniotomy].

OBJECTIVE: To observe the prophylactic effect of granisetron on postoperative nausea and vomiting (PONV) after supratentorial craniotomy. METHODS: Seventy ASA I-II patients undergoing elective supratentorial craniotomy were randomly and double-bindly divided into two groups: control group (Group C, n = 35) and granisetron group (Group G, n = 35). All the patients received either 0.9% NS (Group C) or granisetron 3 mg (Group G) via intravenous injection. The incidences of postoperative nausea and vomiting were recorded at 24 h, 48 h, 72 h after supratentorial craniotomy. RESULTS: The incidence of PONV in Group G was lower than that in Group C (25.7% vs 57.1%, P < 0.01). The incidence of server nausea with vomiting or vomiting in Group G was lower than that in Group C (17.2% vs 48.6%, P < 0.01). CONCLUSION: Granisetron can be used effectively and safely to prevent PONV in supratentorial craniotomy.

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

[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↗
PubMedDate not supplied

A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour), 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6%) children in ketoprofen group had pain at recovery compared to 17/42 (40.4%) in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

Adolescent↗
PubMedDate not supplied

[The central neurophysiological and neurochemical mechanisms of vomiting (a review of the literature)].

The review contains the present-day evidence on neurophysiological and neurochemical mechanisms of functioning the central components of vomiting reflex. The main attention is concentrated on the role of some brain structures in motion sickness-induced vomiting. At the same time, the literature data casting doubt on traditional view of a necessary involvement of some brain structures in the genesis of vomiting induced by motion sickness are discussed. Also there are findings of studying an effect of physiologically active substances (classical neuromediators and regulatory peptides) at a neuronal level (silent postremal cells) with the presence of an emetic effect in them during systemic administration. The current concept of vomiting center to which role the parvicellular reticular formation of brain stem can pretend is under study.

Animals↗
PubMed1992

[Evaluation of SN-307 (ondansetron), given intravenously for the treatment of nausea and vomiting caused by anticancer drugs including cisplatin-open study].

The anti-emetic effect, safety and clinical usefulness of ondansetron for the treatment of nausea and vomiting caused by anticancer drugs including cisplatin, was evaluated by a multi-institutional study in patients with various malignancies. In this study, ondansetron was given intravenously with mainly a single dose of 4 mg to intervene nausea and vomiting. 1. Efficacy ratio of overall effects on nausea and emesis observed for 24 hours after treatment was 69.8%. 2. No side effect was observed. Laboratory tests showed temporary elevation of serum uric acid level in 1 patient in the group given 4 mg. 3. From these results, it seems that ondansetron, given intravenously after initial vomiting, was highly safe and clinically useful anti-emetic for the treatment of nausea and vomiting associated with anti-cancer drugs.

Adult↗
PubMed2003

Comparison of ondansetron, dexamethasone, ondansetron plus dexamethasone and placebo in the prevention of nausea and vomiting after laparoscopic tubal ligation.

Laparoscopic tubal ligation is associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of ondansetron, dexamethasone, ondansetron plus dexamethasone or placebo in the prevention of postoperative nausea and vomiting in patients after laparoscopic tubal ligation. In a prospective, randomised, double blind placebo controlled trial, 160 ASA I-II females received one of four regimens; ondansetron 4 mg, dexamethasone 8 mg, ondansetron 4 mg plus dexamethasone 8 mg or placebo (n=40 each) intravenously immediately before induction of anaesthesia. Patients were then observed for 24 hours postoperatively. The incidence of emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (p<0.001) and ondansetron (p=0.091) and dexamethasone (p=0.143) groups. A complete response (as no postoperative nausea and vomiting) was achieved in 60% of patients given ondansetron, 63% of the patients given dexamethasone, 78% of patients given ondansetron with dexamethasone and 37% of patients received placebo. The prophylactic use of ondansetron with dexamethasone is more effective in preventing postoperative nausea and vomiting.

Antiemetics↗
PubMed1992

Nursing interventions to prevent or relieve postoperative nausea and vomiting.

The purpose of this study was to identify documented interdependent and independent nursing interventions to prevent or relieve nausea and vomiting during the first 24 hours following uncomplicated cholecystectomy. A systematic sampling method was used to select 40 hospital records from 1986 to 1988. Results showed that nausea and vomiting was documented in only two PACU records and nine postoperative nursing unit records. Documentation was typically brief or absent altogether. There was no way to determine if this meant no occurrence of nausea and vomiting or just that interventions were not documented. Lack of interventions may be due to a fear of potentiating the anesthesia or belief that symptoms would subside with time. Documented interventions included repositioning patients (independent) and administering medications (interdependent). This study illustrates the need for education about nurses' responsibility to prevent or relieve postoperative nausea and vomiting and the importance in documenting the interventions used.

Adolescent↗
PubMed1992

The incidence of postoperative nausea and vomiting: a retrospective comparison of alfentanil versus sufentanil.

Postoperative nausea and vomiting have been associated with the use of intravenous narcotics, and nitrous oxide may worsen the emetic effects of narcotics. Alfentanil and sufentanil are two synthetic derivatives of fentanyl; alfentanil has a shorter wake-up time than fentanyl, and sufentanil is equivalent to fentanyl. In order to study comparative emetic properties of these two drugs, patients in two different cities were randomly allocated to two different groups and retrospectively compared. Group I received sufentanil N2O/O2 with 0.25% isoflurane. Group II received alfentanil N2O/O2 with 0.25% isoflurane. With group I, the overall incidence of nausea was 31% and of vomiting was 6.2%. For group II, the overall rate for nausea was 38.2% and 8.8% for vomiting. Statistically, there was no significant difference in nausea or vomiting between groups.

Adolescent↗
PubMedDate not supplied

Cyclic vomiting syndrome: a disease in disguise.

Cyclic vomiting syndrome (CVS) is a childhood disorder characterized by bouts of vomiting that last from a few hours to several days. The current prevalence in the pediatric population is estimated at 2% (Li & Balint, 2000). The vomiting episodes occur in a regular cycle: some children have them every few days, others every few months. Currently, researchers have been unable to determine what causes CVS. Many of the patients and families, however, can identify particular events that seem to trigger the vomiting. Diagnosis can be difficult because CVS does not leave clues that can be found by any current diagnostic test. Lack of knowledge about CVS by physicians, nurses, and the lay public contribute to the helplessness families feel when coping with this disease in disguise. Nursing's primary actions in the care of children and their families affected by CVS should be one of advocacy for diagnosis and support for the family and child through treatment and long term management of this chronic illness.

Adaptation, Psychological↗
PubMed2005

Practical management of chemotherapy-induced nausea and vomiting.

Approximately 70% to 80% of all patients who receive chemotherapy experience nausea and vomiting, which can disrupt their lives in numerous ways. Chemotherapy-induced nausea and vomiting (CINV) has traditionally been classified according to three patterns: acute, delayed, and anticipatory. Additional classifications include refractory and breakthrough nausea and vomiting. The mechanisms by which chemotherapy causes nausea and vomiting are complex, but the most common is thought to be activation of the chemoreceptor trigger zone. An appreciation of the risk factors for developing CINV is important when matching antiemetic treatment to risk. The emetogenicity of the chemotherapy regimen--generally categorized as high, moderate, low, or minimal--greatly affects a patient's risk for developing CINV In addition to established and emerging pharmacologic approaches to managing CINV, many complementary and integrated modalities may be options. Progress in CINV management must include a better understanding of its etiology and a focus on prevention. This review will consider the etiology, assessment, and treatment of patients with CINV.

Antiemetics↗
PubMed2005

[The effect of neostigmine and atropine combination on postoperative nausea and vomiting after arthroscopic surgery].

OBJECTIVES: Postoperative nausea and vomiting prolong the time spent in postanesthesia recovery units. In this study, we investigated the effect of neostigmine and atropine combination, used to avoid residual curarization, on nausea and vomiting. METHODS: The study included 40 ASA I-II patients who were planned to have a short-term arthroscopic operation. The patients were administered a single dose of 0.4 mg/kg atracurium besylate for muscle relaxation, and then, were randomly divided into two groups. In group I, neuromuscular blockade was eliminated with 1.5 mg neostigmine and 0.5 mg atropine, whereas group II patients underwent spontaneous resolution. The patients were evaluated for nausea and vomiting and the need for antiemetic drugs in the recovery unit, patient room, and on the postoperative second day. RESULTS: There were no significant differences between the two groups with respect to hemodynamic parameters and peripheral oxygen saturation. The mean operation time did not differ significantly (p>0.05), but the mean extubation time was significantly shorter in group I (p<0.05). No significant differences were observed for the occurrence of nausea and vomiting and the need for antiemetic drugs in the recovery unit, patient room, and on the postoperative second day (p>0.05). CONCLUSION: In patients undergoing arthroscopic surgery, it is safe to use neostigmine and atropine combination before extubation to avoid residual neuromuscular blockade associated with the use of non-depolarizing myorelaxants.

Adult↗
PubMedDate not supplied

Oral manifestations of a child with chronic vomiting.

Perimolysis is a type of intrinsic erosion--an irreversible dental demineralization linked to chronic regurgitation--which causes teeth to be more susceptible to dental caries. The purpose of this case report was to study a 35-month-old chronic vomiting child who visited the Department of Pediatric Dentistry in Yonsei Dental Hospital, Seoul, South Korea, for an evaluation of and treatment for the loss of tooth structure of his primary teeth. To prevent further destruction of the teeth and maintain occlusal height, all the posterior teeth were restored with stainless steel crowns and all the anterior teeth were restored with resin veneer crowns after pulpal treatment under general anesthesia. Therefore, when a child suffering from chronic vomiting visits a pediatric dental clinic, it is prudent to: (1) perform all possible dental treatment to control vomiting's adverse influences on the oral structures; and (2) refer the patient to a pediatrician to determine the cause of vomiting.

Child, Preschool↗