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PubMed2000

Managing women with nausea and vomiting of pregnancy. Canadian consensus.

QUESTION: I have a 30-year-old pregnant patient who is asthmatic and is taking prednisone. Whenever she decreases her prednisone dose, her nausea increases tremendously even though she is taking two tablets of doxylamine and pyridoxine combination (Diclectin) daily. She is already at 26 weeks' gestation, and I really do not want her to continue the prednisone beyond what is needed for her asthma, but two attempts to taper prednisone off failed because of unbearable nausea. ANSWER: Several controlled trials show the efficacy of prednisone for nausea and vomiting of pregnancy (NVP), but your case is fascinating in proving the point by challenge-rechallenge. You should try to decrease the prednisone while increasing doxylamine and pyridoxine to its recommended dose of two tablets before sleep, one in the morning, and on in the afternoon.

Adult↗
PubMed2000

[Comparison of propofol and isoflurane anesthesia on postoperative nausea, vomiting and pruritus induced by epidural morphine].

We compared propofol-nitrous oxide anesthesia (Group P) with isoflurane-nitrous oxide anesthesia (Group I) on the incidence of postoperative nausea, vomiting and pruritus induced by epidural morphine. Twenty-eight patients for thoracotomy for lung surgeries were randomly assigned either to Group P or Group I. All patients were administrated epidural morphine (4-7 mg.day-1) during and after the operation. The incidence of nausea, vomiting and pruritus was evaluated at the postoperative early (< 9 hour) and late (> 9 hour) periods. In the late postoperative period, in Group P the incidence of nausea and vomiting tended to be low compared with Group I, but the difference was not statistically significant. The incidence of pruritus was not different between the two groups in both early and late periods.

Aged↗
PubMed2000

Critical appraisal of drug therapy for nausea and vomiting of pregnancy: II. Efficacy and safety of diclectin (doxylamine-B6).

Nausea and vomiting of pregnancy is the most common condition in pregnancy and affects up to 80% of all pregnant women. There are a large number of pharmacological agents that are effective for the treatment of nausea and vomiting associated with conditions such as motion sickness and gastrointestinal conditions; however, their use in pregnancy is limited by the lack of sufficient data on their potential teratogenic effects. The efficacy of the delayed-release combination of doxylamine and pyridoxine (Bendectin, Diclectin) has been shown in several randomized, controlled trials. The present review aims to refute the unsubstantiated beliefs that Diclectin is unsafe when used in the treatment of nausea and vomiting of pregnancy.

Antiemetics↗
PubMed2000

Randomised, prospective, controlled trial comparing tropisetron with metoclopramide and placebo in controlling postoperative nausea and vomiting.

OBJECTIVE: To compare the results of Tropisetron, Metoclopramide and placebo on postoperative nausea and vomiting in patients undergoing minilaparotomy cholecystectomy. SETTING: Patients operated for minilaparotomy cholecystectomy in two private hospitals in Karachi. SUBJECTS: Fifty consecutive patients of all ages and both sex who had simple cholelithiasis and underwent minilaparotomy cholecystectomy by a single surgeon. MAIN OUTCOME MEASURES: Postoperative nausea and vomiting (PONV) at 2 hours and within 24 hours and requirement of rescue antiemetic. RESULTS: Tropisetron was better than Metoclopramide and placebo in controlling postoperative nausea and vomiting. CONCLUSION: Tropisetron when given at induction at a dose of 2 mg. intravenously prevents PONV better than Metoclopramide and placebo in 2 hours and 24 hours. It also reduces the need for rescue antiemetic significantly.

Adult↗
PubMed1998

[Clinical study on preventing and treating chemotherapy induced nausea and vomiting using supplemented Inula-Ochrae Decoction].

OBJECTIVE: To observe supplemented Inula-Ochrae Decoction (SIOD) in preventing and treating nausea and vomiting induced by chemotherapy for patients with malignant tumour. METHODS: Seventy-two patients were divided into two groups, the patients in test group took SIOD and in control group using ondensetron, and the efficacy of SIOD in preventing and treating chemotherapy induced nausea and vomiting were studied prospectively with self-intersection approach. RESULTS: The effective rate of treating vomiting due to chemotherapy with DDP and without DDP in the test group was 92.7% and 93.5% respectively, and was higher than that in the control group 87.8% and 87.1%, the difference was insignificant statistically (P > 0.05). CONCLUSIONS: The prescription SIOD could prevent and treat effectively chemotherapy induced nausea and vomiting without any toxic and side effects, and is inexpensive with high efficacy for clinical use.

Adolescent↗
PubMed1997

[EGG and nausea under vestibular stimulus].

81 pilots were exposed to vestibular stimulus with Coriolis acceleration. They were divided into two groups, the first group consisted of 38 pilots with nausea symptoms, the second group 43 pilots without nausea symptom. Dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC), Tachygastria, Bradygastria and normal slow wave components (NSW) of the electrogastrogram (EGG) were analyzed. The results showed that Bradygastria and NSW of EGG were related to nausea symptom of pilots under Coriolis stimulation.

Aerospace Medicine↗
PubMed2001

Management of common symptoms in terminally ill patients: Part I. Fatigue, anorexia, cachexia, nausea and vomiting.

Physical symptoms other than pain often contribute to suffering near the end of life. In addition to pain, the most common symptoms in the terminal stages of an illness such as cancer or acquired immunodeficiency syndrome are fatigue, anorexia, cachexia, nausea, vomiting, constipation, delirium and dyspnea. Management involves a diagnostic evaluation for the cause of each symptom when possible, treatment of the identified cause when reasonable, and concomitant treatment of the symptom using nonpharmacologic and adjunctive pharmacologic measures. Part I of this two-part article discusses fatigue, anorexia, cachexia, nausea and vomiting. Fatigue is the most common symptom at the end of life, but little is known about its pathophysiology and specific treatment. Education of the patient and family is the foundation of treatment with the possible use of adjunctive psychostimulants. Anorexia and cachexia caused by wasting syndromes are best managed with patient and family education, as well as a possible trial of appetite stimulants such as megestrol or dexamethasone. For appropriate pharmacologic treatment, it is helpful to identify the pathophysiologic origin of nausea in each patient.

Anorexia↗
PubMed2001

[Continuous epidural administration of droperidol for the prevention of postoperative nausea].

Continuous antiemetic effect of epidural droperidol was evaluated by prospective, double-blinded study using 145 ASA physical status I-II patients undergoing major gynecological surgery. All patients received bolus epidural infusion of buprenorphine at the end of the operation and continuous epidural infusion of buprenorphine for 48 hours. Patients were divided into 3 groups, 49 patients of Group I received placebo, 50 patients of Group II received only bolus doses of droperidol 2.5 mg and the remaining 46 patients of Group III received continuous epidural infusion of droperidol 10 mg in 48 hours. Visual analogue scales for nausea, the incidence of emetic episodes and side effects were evaluated at 3 hr, 24 hr and 48 hr postoperatively. The scores for nausea were significantly lower in Group III (P < 0.05) compared with Group I 24 hr after the operation. The incidence of emesis was significantly lower in Group III (P < 0.05) as compared with Group I and II 48 hr after the operation. Extrapyramidal side effects and sedative effects were not observed in any patients. The continuous epidural administration of droperidol is effective in prevention of postoperative nausea and vomiting and the effect lasts during its infusion with no side effects.

Analgesia, Epidural↗
PubMed1993

Effect of nitrous oxide on post-operative nausea and vomiting during propofol anaesthesia for short surgical operations.

One hundred patients of ASA status I or II, undergoing gynaecological or urological surgery were studied. Opioids were omitted from premedication and anaesthesia. Patients were allocated randomly to one of two equal groups and were anaesthetized using a computer controlled infusion system, programmed to achieve theoretically any target blood propofol concentration. One group received 60% nitrous oxide in oxygen while the other group received 100% oxygen. Six patients in the nitrous oxide group had nausea and three of these patients vomited. Two patients in the oxygen group had nausea but no patient vomited. The frequency of nausea and vomiting in the two groups was not statistically different (P > 0.05). Theoretical blood propofol concentration shown to produce surgical anaesthesia was maintained in all patients. However 12% of the patients that received nitrous oxide and 40% of the patients that did not, responded to the surgical stimulus by limb movement. Patients in the oxygen group required higher rates of propofol infusion to maintain surgical anaesthesia.

Adolescent↗
PubMedDate not supplied

Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia.

In this randomized study we compared the efficacy of ondansetron 4 mg with ondansetron 8 mg for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Sixty patients were randomized to receive ondansetron 8 mg (30 pts) or ondansetron 4 mg (30 pts) before the induction of anaesthesia with thiopental and remifentanil. Anaesthesia was maintained with sevoflurane (0.5 MAC), oxygen and remifentanil infusion (0.25, 0.35, 0.5 microg/kg/min). Postoperative analgesia was provided by intravenous ketorolac 60 mg. The incidence of PONV, the pain score, and the analgesic requirement were recorded for 24 hours. There was no difference among groups in patient characteristics, risk factors for PONV, or side effects. During the first 6 h postoperatively, the incidence of PONV after ondansetron 4 mg and 8 mg were similar (p < 0.001). After 6 h the incidence of PONV increased significantly in patients who had received ondansetron 4 mg (p = 0.01) and was greater than that in patients who had received ondansetron 8 mg (p = 0.001). We conclude that single-dose ondansetron 8 mg is more effective than ondansetron 4 mg in the prevention of PONV after laparoscopic cholecystectomy. This surgery is associated with a high incidence of postoperative nausea and vomiting. A single dose of IV ondansetron 8 mg is well tolerated and decrease the number of nausea and vomiting episodes after surgery.

Adult↗
PubMed2002

Adding droperidol to morphine patient-controlled analgesia: effect on nausea and vomiting.

This prospective, double-blind, randomized, controlled trial was performed to evaluate the antiemetic effectiveness and side effects of adding droperidol to morphine delivered via a patient-controlled analgesia (PCA) device in 94 women undergoing transabdominal hysterectomy with a standardized anesthetic regimen. They were randomly allocated to receive postoperative PCA as either bolus doses of morphine I mg or a combination of morphine 1 mg and 0.0625 mg droperidol with a lockout interval of 5 minutes and no continuous infusion. The incidence of nausea 6-18 hours postoperatively and 18-24 hours postoperatively was significantly lower in the morphine and droperidol group than in the morphine only group and its severity 2-6 hours, 6-18 hours, and 18-24 hours postoperatively was significantly lower. The number needed to treat to prevent nausea comparing the morphine only group at 6-18 and at 18-24 hours postoperatively were 4 and 4 (95% CI 2-27 and 2-11, respectively). The amount of morphine used 6-18 hours postoperatively in the droperidol group was lower than in the morphine only group. Although the incidence of vomiting and the amount of rescue antiemetics were lower in the morphine and droperidol group, the difference was not statistically significant. Postoperative pain scores were not different between the groups. No patients were oversedated. A series of extrapyramidal reactions were observed in one patient in the morphine and droperidol group. The drug and consumable item cost was not different between the groups. We conclude that droperidol added to morphine in PCA reduces nausea. The appropriate dose of droperidol should be further investigated to reduce the incidence of vomiting.

Adult↗
PubMed1976

Persistent Nausea without organic cause.

The onset of functional nausea among 77 patients was frequently related to an organic disease or to a psychophysiologic response to stress. Later, the nausea had obvious features of conversion, hypochondriasis, or an hallucination. The patients had significant psychiatric disorders as assessed by the Minnesota Multiphasic Personality Inventory (MMPI) and by clinical examination. While in the hospital most patients experienced symptomatic improvement but they did not accept a psychologic explanation for their nausea.

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

Nausea and vomiting of pregnancy.

Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as ginger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxylamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition.

Acupressure↗
PubMed1992

Oral ondansetron in the prevention of postoperative nausea and vomiting.

The effect of three times daily oral ondansetron in preventing postoperative nausea and vomiting was investigated in two randomized, double-blind, placebo-controlled, multi-centre studies. The first study compared ondansetron 1, 8 and 16 mg to placebo, and the second study compared 8 mg ondansetron to placebo. Both studies included ASA Class I-III female patients about to undergo major abdominal gynaecological surgery or vaginal hysterectomy. In the first study, the 8 and 16 mg ondansetron groups had a significantly lower incidence of nausea and vomiting in the 0-24 h period following recovery from anaesthesia than the placebo group. Ondansetron 8 mg three times daily was also significantly better than placebo in the second study. Side-effects mainly consisted of constipation, headache, and asymptomatic elevation of liver enzymes. The incidence of side-effects was similar in ondansetron- and placebo-treated patients. There appeared to be no clinically important benefit of the 16 mg three times daily ondansetron regimen over the 8 mg three times daily dose, therefore 8 mg three times daily is recommended as the optimal oral dose in the prevention of postoperative nausea and vomiting.

Administration, Oral↗
PubMed1992

[Evaluation of SN-307 (ondansetron), given intravenously in the treatment of nausea and vomiting caused by anticancer drugs including cisplatin--a placebo-controlled, double-blind comparative study].

Clinical usefulness of ondansetron as an antiemetic for the treatment of nausea and vomiting induced by anticancer drugs including cisplatin (> or = 50 mg/m2) was evaluated by a multi-institutional, double-blind comparative study with placebo with inpatients with various malignancies. In this study, efficacy, safety and usefulness of single dose of ondansetron (4 mg) or placebo (physiological saline), given intravenously for initial nausea and vomiting were observed for 24 hours after treatment. Clinically, very effective or effective response was seen in 64% (16/25) of the group O (ondansetron) and 5.9% (1/17) of the group P (placebo). No clinically significant adverse effects or abnormal laboratory test values were reported in the group of O. Diarrhea (1 case) and the elevation of laboratory test values (GOT.GPT, T-bilirubin, LDH, in 3 cases) were reported in the group of P. General safety assessment was considered "safe" in 100% of both group O and group P, and there was no statistical difference between two groups. Usefulness was considered as "useful" in 64% (16/25) of group O and 6.3% (1/16) of group P, and O was significantly better than group P (p < 0.001) level. In conclusion, ondansetron provides a safe and effective antiemetic measure when employed therapeutically against nausea and vomiting induced by regimens including cisplatin.

Adult↗
PubMedDate not supplied

Postoperative nausea and vomiting in diagnostic gynaecological laparoscopic procedures: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron.

BACKGROUND AND OBJECTIVE: This study was conducted in a tertiary hospital with the aim of comparing the efficacy of a combination of dexamethasone and metoclopramide with dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting [PONV] after diagnostic gynaecological laparoscopic procedures. SUBJECTS AND METHODS: In this prospective, randomised, double-blind study, 120 women received either saline I.V. [Group I, n=40]; a combination of dexamethasone [8 mg] with metoclopramide [10 mg] [Group II, n=40]; or a combination of dexamethasone [8 mg] with ondansetron [4 mg] [Group III, n=40] prior to induction of general anaesthesia. PONV was evaluated at regular intervals. The results were analysed using one-way ANOVA, post-hoc, Chi-square, Kruskal-Wallace tests and Z test for proportions where appropriate through a SPSS V.9 package. RESULTS: The 3 groups were well matched for demographic characteristics. The incidence of nausea and emesis was significantly lower in Group III [[17.5%, P <0.02] and [10%, P <0.01] respectively]. Nausea scores were also lower in Group III [P <0.02]. Rescue anti-emetic requirements were higher in Group I [P <0.05] as compared to Groups II and III. CONCLUSIONS: A combination of dexamethasone and ondansetron was more efficacious as compared to that of metoclopramide and dexamethasone. The combination of metoclopramide and dexamethasone seems to offer no additional benefit as compared to saline placebo.

Adult↗
PubMed2004

[Unraveling the myths about nausea and vomiting during pregnancy].

Nausea and vomiting are the most uncomfortable symptoms of early pregnancy. They also affect many pregnant women. Recent research has shown that nausea and vomiting are not simply pathological issues; they also reflect psychosocial and cultural factors. These are complex and diverse phenomena, but their influences on pregnant women are often underestimated. The long-term disregard of these phenomena has not only affected our actual understanding of them, but also given rise to many misconceptions. With some of these misconceptions there is no proof. With others, there has not even been any scientific research, and yet they have become prevalent, fusing together with the passage of time to become a sort of mythology. This has profoundly affected care provision, the pregnant women themselves and also their families. It also explains why so many pregnant women with the symptoms cannot receive proper care. On that basis, this article categorizes these common myths, having established their numbers by means of research, and uses a theoretical basis as the foundation from which to further discuss and clarify them, in order to promote an accurate understanding of the problems of nausea and vomiting as they affect pregnant women, to assist nurses caring for such women and their families.

Female↗