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PubMed1990

Relationship between small intestinal fasting motility and vomiting in dogs.

Preceding vomiting, several changes in small intestinal motility have been described. They consist mainly of high-amplitude retrograde contractions and inhibition of motility before and after these contractions. The recordings of 94 episodes of emesis occurring spontaneously, during manometric studies of intestinal motility by means of infused catheters in dogs with gastric and duodenal cannulae, showed that 95.7% of all episodes developed during phase II of the migratory motor complex. In order to establish whether different phases of the fasting cyclic activity are associated with a different sensitivity to emetic stimulus, two agents, apomorphine, a centrally acting drug and copper sulfate, a peripherally acting agent, were administered at the beginning of phases I and II of the migratory motor complex. Coincident with spontaneously occurring vomiting, a statistically significative greater number of responses to both emetic agents was observed during phase II as compared to phase I. This finding suggests that cyclic changes of the small bowel motility are related to changes in the threshold of the vomiting center.

Animals↗
PubMed1994

Behavioral medicine treatment of ruminative vomiting and associated weight loss in an adolescent with autism.

Treated persistent ruminative vomiting of a 15-year-old boy with autism using a multicomponent behavioral medicine program within a residential facility. Preceding intervention the boy had lost 15 pounds associated with high-rate ruminating. The treatment program included a combination of dietary, nutritional, and behavioral procedures that emphasized food restrictions, satiation, and setting condition manipulations. Ruminative vomiting was reduced to near-zero levels and weight gain was achieved following treatment implementation. These therapeutic gains were sustained during a maintenance programming phase and at 1- through 4-month follow-up assessments. Issues related to functional assessment and treatment formulation in behavioral medicine intervention for ruminative vomiting are discussed.

Adolescent↗
PubMed1989

Intraoperative prochlorperazine for prevention of post-operative nausea and vomiting.

The effectiveness of 10 mg IV prochlorperazine in preventing postoperative nausea and vomiting was compared with placebo when given perioperatively to 100 patients in a prospective double-blind randomized trial. The occurrence of nausea and vomiting was assessed in the recovery room prior to and after narcotic administration for pain relief. No statistically significant difference in the frequency of postoperative nausea and vomiting was found between the treatment and control groups.

Adult↗
PubMed1992

Ineffectiveness of acupuncture and droperidol in preventing vomiting following strabismus repair in children.

The antiemetic effects and side-effects of P6 acupuncture and droperidol pre-treatment were evaluated in a randomized, patient- and observer-blinded study. Ninety unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair, and aged over one year, were studied. All patients received intravenous thiopentone 5 mg.kg-1, atropine 0.02 mg.kg-1 and succinylcholine 1.5 mg.kg-1, and the trachea was intubated. Patients then received either intravenous droperidol 0.075 mg.kg-1, droperidol plus five minutes' P6 acupuncture, or acupuncture alone. Anaesthesia was maintained with nitrous oxide 66% and halothane 1.5-2.0% in oxygen with spontaneous ventilation. There was no difference in the incidence of vomiting in the droperidol group (17% before discharge from hospital and 41% up to 48 hours after discharge), combined treatment group (17% and 34% respectively) and acupuncture group (27% and 45% respectively). Corresponding figures for the incidence of vomiting before discharge were 17%, 17% and 27% respectively; these values were also not different. The incidence of restlessness was significantly greater in children receiving droperidol (63%) or both treatments (67%) than in those receiving acupuncture alone (30%; P = 0.007). P6 acupuncture and droperidol are equally ineffective in preventing vomiting within 48 hours of paediatric strabismus repair. Droperidol is associated with increased incidence of postoperative restlessness.

Acupuncture Therapy↗
PubMed1995

Oral clonidine premedication reduces vomiting in children after strabismus surgery.

This is a prospective randomized double-blind trial conducted to determine whether preoperative orally administered clonidine causes or potentiates postoperative vomiting in 140 children (3-12 yr) undergoing strabismus surgery. They were all inpatients and classified randomly into four groups (n = 35 each); placebo (control), diazepam 0.4 mg.kg-1, clonidine 2 micrograms.kg-1, and clonidine 4 micrograms.kg-1. These agents were administered 93-112 min (mean; 100 min) before the anticipated time of induction of anaesthesia. All children received inhalational anaesthesia with halothane and nitrous oxide in oxygen. Muscle relaxation in all patients was obtained with vecuronium and residual neuromuscular blockade was antagonized with neostigmine and atropine before tracheal extubation. Diclofenac suppository was prescribed to prevent postoperative pain. No opioids or postoperative antiemetics were administered. All children remained in hospital for two days postoperatively. The incidence and frequency of vomiting were compared in the groups with Kruskall-Wallis Rank test. Clonidine 4 micrograms.kg-1 caused a lower incidence and frequency of vomiting than did placebo and diazepam (incidence and frequency: 11% and 1.37% and 3, and 34% and 2 in clonidine 4 micrograms.kg-1, placebo, and diazepam, respectively; P < 0.05 for clonidine 4 micrograms.kg-1 vs placebo and diazepam). However, low-dose clonidine was ineffective. These data suggest that preanaesthetic medication with clonidine 4 micrograms.kg-1 may be useful for preventing emesis following strabismus surgery. This property of clonidine indicates that it may be superior to other sedative premedicants such as diazepam and midazolam.

Administration, Oral↗
PubMed1996

Treatment of postoperative nausea and vomiting: comparison of propofol, droperidol and metoclopramide.

PURPOSE: To compare the efficacy of propofol in a subhypnotic dose (10 mg iv), droperidol (1.25 mg iv), or metoclopramide (10 mg iv) in the treatment of PONV in the post anaesthesia care unit (PACU). METHODS: In a prospective, randomized, double-blind protocol, over four months, all eligible inpatients and outpatients were asked to give their consent to be included in the study should they suffer PONV in the PACU. They received a standardized general anaesthetic without any prophylactic antiemetic drug. In the recovery room, patients complaining of persistent nausea (lasting more than ten minutes) and/or experiencing at least two episodes of retching or vomiting were given one of the three study drugs. Recurrence of retching or vomiting was recorded for 60 min after administration of the study drug and nausea severity was assessed on a visual analog scale. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication (dimenhydrinate). RESULTS: Seventy-eight patients received one of the study drugs. The recurrence of retching or vomiting was higher with propofol (58%) than with droperidol (4%) or metoclopramide (24%) (P < 0.001). More patients who received propofol needed the rescue medication (54%) than those who received droperidol (15%) or metoclopramide (28%) (P < 0.02). No difference was observed in nausea severity. CONCLUSION: A subhypnotic dose of propofol (10 mg iv) is less effective than the conventional antiemetic drugs droperidol and metoclopramide for the treatment of PONV in the PACU.

Adult↗
PubMed1994

Optimal anti-emetic dose of granisetron for preventing postoperative nausea and vomiting.

In order to determine the optimal effective dose of granisetron for preventing postoperative nausea and vomiting, the drug was administered in doses of either 20, 40 or 60 micrograms.kg-1. The efficacy of granisetron was evaluated in a randomized, double-blind comparison with placebo in 100 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single dose of either granisetron or placebo (saline) iv immediately after recovery from anaesthesia. The effects were assessed during the 24 hr after recovery from anaesthesia by means of a nausea and vomiting score; 0 = no emetic symptoms, 1 = nausea, 2 = vomiting. The treatment groups were similar for patient characteristics, surgical procedures and anaesthetics administered. The mean scores were 0.7, 0.6, 0.2 and 0.2 after administration of placebo, granisetron 20, 40 and 60 micrograms.kg-1, respectively. Granisetron 40 micrograms.kg-1 was as effective as 60 micrograms.kg-1 and both resulted in reduction of the scores compared with placebo and granisetron 20 micrograms.kg-1 (P < 0.05). In conclusion, granisetron 40 micrograms.kg-1 is considered to be the appropriate dosage for preventing postoperative emesis after anaesthesia.

Adult↗
PubMed1997

Vomiting after strabismus surgery in children: ondansetron vs propofol.

PURPOSE: To compare the antiemetic efficacy and costs associated with two anaesthetic regimens in children undergoing strabismus surgery. One regimen contained halothane, nitrous oxide and ondansetron, while the other contained propofol and nitrous oxide. METHODS: Three hundred children aged 2-14 yr undergoing strabismus surgery were enrolled into this single-blind, randomized, stratified, blocked study with a balanced design. Anaesthesia was induced by inhalation with halothane/N2O/O2 (Group O) or with 2.5-3.5 mg.kg-1 propofol + 0.5 mg.kg-1 lidocaine i.v. (Group P). Group O patients were administered 0.15 mg.kg-1 ondansetron (maximum dose 8 mg) i.v. and all patients received atropine 20 micrograms.kg-1 i.v. immediately after induction of anaesthesia. Anaesthesia was maintained with N2O and halothane (Group O) or N2O and propofol (Group P). Patients were followed for 24 hr after their operation primarily to assess the incidence of postoperative vomiting. For each case, the costs of the anaesthetic drugs administered and their associated intravenous administration tubing were determined. Drug costs were those prevailing at the study site at the time of the investigation. Fixed costs, such as the cost of the anaesthetic equipment were not assessed. RESULTS: Groups were similar with respect to demographic data. The incidence of vomiting in both groups was 11% while in-hospital and 23% after discharge. Each episode of in-hospital vomiting prolonged discharge by 17 +/- 4 min, P < 0.001. Mean cost per case for anaesthetic drugs was less in Group O, 18 +/- 8 vs 21 +/- 10, CDN$, mean +/- SD, P < 0.01. CONCLUSION: The two methods of antiemetic prophylaxis were equally effective. Propofol-based anaesthesia was more expensive.

Adolescent↗
PubMed1999

Post discharge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis.

PURPOSE: To determine the incidence of post-discharge nausea and vomiting (PDNV) following outpatient laparoscopic procedures in women, and to assess the efficacy of the prophylactic administration of promethazine prior to discharge from hospital. METHODS: Ninety-five healthy women scheduled for ambulatory laparoscopic cholecystectomy or gynecological surgery completed this double blind, placebo controlled study. A standardized fentanyl-propofol-nitrous oxide-isoflurane anesthetic was used, and all patients received 0.5 mg droperidol i.v., intraoperatively. Subjects were randomized to receive 0.6 mg x kg(-1) promethazine or placebo i.m. prior to transfer from the post-anesthetic recovery (PAR) unit. The incidence and severity of nausea, pain, and drowsiness were documented using patient diaries at four time intervals during the first 24 hr postoperatively using four-point self-assessment scales. RESULTS: After discharge home, the overall incidence of nausea was 48%, moderate to severe nausea 30%, vomiting 17% and rescue antiemetic use 28%, with no difference between those receiving saline or promethazine. The need for antiemetics in the PAR was associated with subsequent PDNV, with those requiring PAR antiemetics being four times as likely to vomit after discharge (P = 0.008). CONCLUSION: Despite the prophylactic administration of 0.5 mg droperidol i.v., patients undergoing ambulatory laparoscopic surgery reported a high incidence of nausea after discharge. Patients requiring antiemetics in the PAR were at higher risk for PDNV. The incidence of nausea was not altered by prophylactic administration of 0.6 mg x kg(-1) promethazine i.m. before discharge.

Adult↗
PubMed2003

Dexamethasone prevents postoperative nausea and vomiting more effectively in women with motion sickness.

PURPOSE: To evaluate the antiemetic effect of iv dexamethasone for preventing postoperative nausea and vomiting (PONV) in women with and without a history of motion sickness. METHODS: This randomized, double-blinded, placebo-controlled study was carried out in 168 female patients with (n = 84) and without (n = 84) a history of motion sickness undergoing gynecological laparoscopy. Patients received 8 mg dexamethasone or saline immediately before induction of anesthesia. Postoperatively patients were assessed for 24 hr for nausea, vomiting, and complete response (no vomiting, no need for rescue antiemetics). RESULTS: The complete response for patients with a history of motion sickness was 80.5% and 37.5% for recipients of dexamethasone and saline, respectively [P < 0.001; number needed-to-treat (NNT) = 2.3]; with corresponding incidences of 83.3% and 53.7% when there was no such history (P = 0.009; NNT = 3.4). Calculation of the efficacy of dexamethasone for the different subgroups shows that dexamethasone was 45.3% more effective in patients with motion sickness than in those without it. CONCLUSIONS: Prophylactic administration of dexamethasone is effective in reducing PONV in patients with and without a history of motion sickness. The results of this study were more favourable in patients with a history of motion sickness, demonstrating a higher effectiveness of dexamethasone for preventing PONV in this subgroup of patients.

Adult↗
PubMed2002

P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women.

PURPOSE: To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting (PONV) after gynecological surgery in the everyday clinical setting (effectiveness study). METHODS: Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospective, consecutive, randomized, multicentre, placebo-controlled, double-blind clinical trial with a reference group. One group was given bilateral P6 acupressure (n = 135), a second group similar pressure on bilateral non-acupressure points (n = 139), and a third group (n = 136) served as reference group. Nausea (scale 0-6), vomiting, pain, and satisfaction with the treatment were recorded. Primary outcome was complete response, i.e., no nausea, vomiting or rescue medication for 24 hr. Results were analyzed by applying logistic regression with indicators of treatments, type of operation and risk score for PONV as explanatory variables. RESULTS: Complete response was more frequent in the P6 acupressure group than in the reference group (P = 0.0194) Conversely, the incidence of PONV was 46% in the reference group, 38% after pressure on a non-acupoint and 33% after P6 acupressure. The decrease from 46% to 33% was statistically significant. When considering vaginal cases separately, the decrease in PONV was from 36% to 20% (P = 0.0168). The corresponding decrease from 59% to 55% in the laparoscopic surgery group was not statistically significant. CONCLUSION: P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery.

Acupuncture Therapy↗
PubMed2003

Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control.

PURPOSE: To evaluate the prophylactic effect of ondansetron on nausea and vomiting following epidural morphine for postoperative pain control. METHODS: Seventy women (n = 35 in each group) undergoing abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg for postoperative pain relief. Before morphine injection, the ondansetron group received iv ondansetron 4 mg, whereas the placebo group received iv saline. RESULTS: Patients in the ondansetron group reported a lower frequency of total postoperative nausea and vomiting (22%) and lower frequency of rescue antiemetic request (12%) than those in the placebo group (52% and 39%, respectively; P < 0.05). In addition, ondansetron was associated with a reduced incidence of pruritus following epidural morphine (28% vs 58%; P < 0.05). CONCLUSION: We conclude that iv ondansetron 4 mg is effective in the prevention of nausea, vomiting, and pruritus following epidural morphine for postoperative pain control.

Adult↗
PubMed2003

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy.

OBJECTIVE: Nowadays, microsurgical discectomy is being performed as an outpatient procedure. A retrospective chart review was done to document factors that delayed discharge or led to unanticipated admission. METHODS: After Institutional Review Board approval, the hospital medical records of 106 patients who underwent microsurgical discectomy on an ambulatory basis were reviewed. All patients were operated upon by a single surgeon at the Toronto Western Hospital. Perioperative data were collected on specifically designed data sheets. All anesthetic and surgical factors that affected discharge were noted. RESULTS: Of the 106 patients reviewed, only six required unanticipated admission. Two patients were admitted due to nausea and vomiting, one due to severe pain, one due to urinary retention and two were surgical causes (dural tear). Eight patients had delayed discharge. Anesthesia causes were severe nausea, severe pain, low oxygen saturation, sore throat and dry eyes. Two patients had surgical causes. The incidence of postoperative nausea was 61% and postoperative vomiting was 9.4%. Eighty patients (75.4%) complained of pain in the postanesthesia care unit. Of these, 33.9% had visual analogue pain scale scores more than 6. CONCLUSION: Ambulatory lumbar microdiscectomy can be carried out as an ambulatory procedure with an acceptably low unanticipated admission rate (5.7%). The percentage of patients with severe nausea (16%) and pain (33.9%) is high. Adequate perioperative pain management and effective control of nausea and vomiting may further improve the patients' experience after anesthesia for ambulatory microdiscectomy.

Adult↗
PubMed2004

[Vomiting after gynecologic laparoscopy and under general anesthesia is associated with changes in excretion of serotonin metabolites].

INTRODUCTION: The efficacy of 5-HT(3)-receptor antagonists suggests a role of serotonin in the pathogenesis of postoperative nausea and vomiting (PONV). However, studies investigating the relationship between the turnover of serotonin and PONV were contradictory. Therefore we carried out a pilot study in order to find out whether results can be obtained that would justify further studies on a larger scale. METHODS: A total of 22 patients scheduled for elective gynaecological laparoscopy were enrolled. A balanced anaesthesia using sufentanil, etomidate, cisatracurium, isoflurane and nitrous oxide was administered and 5-hydroxyindoleaceticacid (5-HIAA) concentrations in the urine were measured within the 24 h after surgery. RESULTS: Only the patients that vomited postoperatively had a significant change in the concentrations of 5-HIAA over the time course investigated. However, comparison of urinary 5-HIAA concentrations of the group comprising patients that vomited with those that had no PONV did not reveal a significant difference. CONCLUSIONS: Results of this study support further investigation of the relationship between serotonin and PONV and suggest that there may in fact be an association between PONV and increased serotonin turnover.

Adolescent↗
PubMed2000

Postoperative nausea and vomiting after Faden operation.

OBJECTIVE: The purpose of this study was to evaluate the antiemetic effect of prophylactic dimenhydrinate application prior to Faden operation and to compare the incidence of PONV between bimedial Faden operation (BMF) and horizontal recess-resect procedure (R&R). METHODS: Ninety-nine children (4-10 years) scheduled for BMF were included in this prospective double-blind study. Midazolam (0.5 mg/kg body weight, BW) was administered orally for premedication 30 min before induction of anesthesia. Additionally, children weighing >/=23 kg received either dimenhydrinate suppositories or placebo. The placebo group was compared with 148 children who underwent R&R surgery without antiemetic prophylaxis during the same period. Anesthesia was induced with thiopentone (5-10 mg/kg BW) and vecuronium (0.1 mg/kg BW) bromide and maintained with halothane (1-2 vol%) in N(2)O/O(2) (65/35 vol%). Age, height, weight, and incidence of oculocardiac reflex were documented. PONV was classified into "no vomiting", "vomiting without therapy", and "vomiting requiring rescue medication". In the latter case dimenhydrinate was given again. The chi-square test was used for statistical analysis. RESULTS: Forty-eight patients received placebo, while 51 received dimenhydrinate. No differences between any groups were observed concerning age, height, weight, and incidence of oculocardiac reflex. Compared to R&R surgery, PONV requiring rescue medication occurred significantly more frequently after BMF (45% vs 23% after R&R). PONV after BMF was significantly less severe in the dimenhydrinate group than in the placebo group. The total incidence of PONV after BMF, however, was not significantly reduced. CONCLUSION: The high incidence of PONV after BMF can be explained by the greater invasiveness of BMF than R&R surgery. PONV requiring antiemetic rescue medication can be reduced by preoperative administration of dimenhydrinate suppositories.

Anesthesia, Local↗
PubMed2000

Cyclic vomiting syndrome and food allergy/intolerance in seven children: a possible association.

UNLABELLED: Cyclic vomiting syndrome (CVS) is characterized by repeated unpredictable, explosive and unexplained bouts of vomiting. The episodes have a rapid onset, persist over a number of hours or days, and are separated by symptom-free intervals. Despite the recent interest in this disorder, its aetiology, pathogenesis and even its target organ remain unknown. The purpose of this study is to investigate the role played by food allergy in CVS. The report concerns eight children (five male, three female), mean age 8 years (3-13 years), suffering from CVS for 2 years at least. The diagnosis of CVS was based on characteristic history, normal physical examination and negative laboratory, radiographic, neurological and endoscopic studies. Despite the absence of clinical signs typical of food allergy, skin prick tests were positive in six of the eight patients (75%). Specific IgE were present in 4/8 (50%) of the patients. Skin tests and specific IgE were positive for cow's milk proteins, egg white and soya. IgE levels were higher than the mean + 2SD in 5/8 (63%) of the patients. A double blind placebo controlled food challenge (DBPCFC) was carried out on seven of the eight patients who displayed clinical improvement after an elimination diet for cow's milk (and other foodstuffs indicated by positive skin tests). The DBPCFC was positive in all seven children. Clinical follow-up revealed a state of well-being over the 6 months of observation. CONCLUSION: It appears reasonable to suggest that food allergy plays a role in cyclic vomiting syndrome.

Adolescent↗
PubMed2001

Ondansetron in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: There is an increased incidence of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. The aim of the study was to evaluate the efficacy of intravenous ondansetron, a 5-HT anatagonist, for prevention from PONV after laparoscopic cholecystectomy. METHODS: Sixty-eight patients were entered into the study. Thirty-six patients were randomized to receive a single intravenous dose of 4 mg of ondansetron before extubation. Thirty-two patients received no prophylaxis. There were no differences in terms of sex ratio, age, ASA status, and duration of operation between the two study groups. Patients were interviewed by an independent observer to assess the postoperative pain and nausea using visual analog score. Patients' satisfaction scores to the procedure were measured. RESULTS: There was no complication in the series. Pain scores at 2 and 24 h after operation and analgesics consumption were not different between the two groups. For the patients who received ondansetron, the mean (SD) nausea score at 2 and 24 h was 1.5 (1.2) and 1.4 (1.4), respectively. The score for the control group was 1.4 (1.0) and 1.2 (0.5), respectively. There was also no difference in episodes of vomiting and usage of antiemetics between the two groups. Both groups were equally satisfied with the procedures. CONCLUSION: Routine use of ondansetron does not reduce the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy.

Adult↗
PubMed2003

Granisetron in the control of nausea and vomiting associated with bone marrow transplantation: a review of its efficacy and tolerability.

Cancer patients undergoing bone marrow transplantation (BMT) experience severe nausea and vomiting associated with high-dose chemotherapy agents; these emetic symptoms are compounded by total body irradiation used in many conditioning regimens. This paper reviews clinical experience with the 5-HT(3) receptor antagonist granisetron, both as a single agent and in combination with other anti-emetics, in patients undergoing BMT and peripheral blood stem cell transplantation (PBSCT). Clinical studies demonstrate the efficacy (47-61% with no vomiting and no worse than mild nausea) and tolerability of granisetron. Its long half-life and duration of action may be responsible for its effective 24 h control of nausea and vomiting in BMT patients.

Administration, Oral↗