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PubMed1989

Preoperative transdermal hyoscine for the prevention of postoperative nausea and vomiting.

In a randomised, double-blind study, a transdermal patch containing either hyoscine or placebo was applied post-auricularly in 190 adult patients under 65 year old, seven to twelve hours prior to their undergoing minor orthopaedic or plastic surgery under thiopentone/nitrous oxide/halothane general anaesthesia. In the first 24 hours after surgery 34% of patients vomited. The incidence of nausea (31% vs 54%; P less than 0.01) and the number of episodes of vomiting (66 vs 125; P less than 0.05) during the first 24 hours were significantly less with hyoscine than with placebo. The hyoscine group required fewer doses of antiemetic than the placebo group (12 vs 27; P less than 0.05). Side-effects were mild, the only difference between the two groups being the frequency of dry mouth immediately preoperatively. No differences were seen in the second 24 hours after surgery. We conclude that transdermal hyoscine is moderately effective in reducing the occurrence of postoperative nausea and vomiting following minor surgery.

Administration, Cutaneous↗
PubMed1995

Pain and vomiting after vitreoretinal surgery: a potential role for local anaesthesia.

Periconal local anaesthesia with subtenon supplementation was used to provide anaesthesia for 94 patients having vitreoretinal surgery. Of these, 44 patients also received general anaesthesia with neuromuscular block. None of these patients received opioid or antiemetic before or during surgery. In comparison with a retrospective control group, patients who had received local anaesthesia as part of their anaesthetic technique were less likely to be given a parenteral opioid (P < 0.001) or to vomit (P < 0.001) within six hours of the completion of surgery. They also experienced significantly fewer bradycardic episodes during surgery (P = 0.001). For patients having general anaesthesia, administration of an intraoperative antiemetic reduced the incidence of vomiting within six hours of the completion of surgery (P = 0.008). For patients who did not receive local anaesthetic, shorter operating time was a factor associated with both reduced postoperative vomiting (P = 0.0015) and administration of parenteral opioid (P = 0.0014). It is suggested that the use of local anaesthesia as part of the anaesthetic technique for vitreoretinal surgery is associated with improved patient comfort.

Analgesics, Opioid↗
PubMed1987

Integrating systems theory and attachment theory: the use of radio communication to modify attachments in a patient with psychogenic vomiting.

A case is presented that shows the usefulness of integrating systems theory and attachment theory in the formulation and treatment of a clinical problem. The 5 year old son of East Indian immigrants presented with persistent psychogenic vomiting associated with pathological family attachments. It was evident that the precarious family equilibrium was stabilized by the child's psychogenic vomiting. The therapeutic team suggested to the family that their problems might be more satisfactorily resolved if the mother and child maintained their link by two-way radio. Three weeks later the vomiting had ceased, the child no longer felt that he needed the radio and both parents had established new patterns of relating to their child, whose attendance and peer socialization at school showed marked improvement. To some extent the rapid resolution of the problems was facilitated by the cultural strengths of the family.

Acculturation↗
PubMed1988

The unseen tears of children: a Chinese boy who vomited for 14 months.

A Chinese boy in Hong Kong who vomited for 14 months after his father had gone abroad to work is reported. Despite the very obvious predicament and sadness, more than 30 doctors had failed to understand the patient. In their search for a disease to explain the symptom, they trapped both themselves and the patient in the symptom of vomiting. It is argued that this patient should have been understood not from the angle of the traditional medical model. Neither was the psychoanalytical model useful. Rather the communication model of hysteria is much more practical; the vomiting can be construed as the unseen tears of a boy entrenched helplessly in his predicament. These unseen and unrecognized tears had cost the patient 14 months of precious life.

Child↗
PubMedDate not supplied

Acupressure wrist bands to relieve nausea and vomiting in hospice patients: do they work?

This study assessed the effects of acupressure wrist bands on the nausea and vomiting of terminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions: An acupressure wrist band; A placebo wrist band; A no wrist band condition. Patients and their caregivers rated nausea and vomiting during the treatment. Despite some difficulty obtaining complete data, the results of this preliminary test indicate that acupressure wrist bands were not effective in reducing nausea and vomiting in this small sample of hospice patients.

Acupuncture Points↗
PubMed1994

Recommendations by clinicians for nausea and vomiting of pregnancy.

The purpose of this study was to assess both the current use of relief measures for nausea and vomiting of pregnancy among clinicians and the basis for their decisions regarding method of treatment. With the permission of conference sponsors, questionnaires on nausea and vomiting of pregnancy relief measures were distributed at a national conference for obstetrical health care providers. Of the 600 conference participants, 130 completed questionnaires. The findings of the study indicate that clinicians generally recommend eating small, frequent meals; that clinicians modify their recommendations slightly based on the severity of the symptoms; that clinicians perceive varying degrees of effectiveness of relief measures, with no one measure being totally effective; and that clinicians look to patients as the primary resource for information about nausea and vomiting of pregnancy.

Adult↗
PubMed1989

Intravenous erythromycin lactobionate-induced severe nausea and vomiting.

Intravenous erythromycin lactobionate has been used for several years to treat various infectious diseases. Several cases of severe nausea and vomiting associated with its use have been reported in Europe but only a few cases have been reported in the U.S. The official product information does not refer to severe nausea and vomiting associated with its intravenous use; however, we report six additional cases of severe nausea and vomiting associated with rapid administration of erythromycin lactobionate, and review the current literature on the characteristics of this adverse effect.

Adult↗
PubMed1993

Use of ondansetron for control of projectile vomiting in patients with neurosurgical trauma: two case reports.

OBJECTIVE: To describe two cases of projectile vomiting that were treated successfully with ondansetron in patients with neurosurgical trauma. Causes and pharmacologic treatments for nausea and emesis are also discussed. DATA SOURCES: Patient data and literature citations from published case reports, review articles, and clinical research reports as identified by MEDLINE. DATA SYNTHESIS: Ondansetron, a potent and highly selective antagonist of serotonin at the 5-HT3 (subtype 3)-receptor, possesses potent antiemetic effects. It has not been associated with the extrapyramidal adverse effects seen with traditional antiemetics. The occurrence of extrapyramidal reactions may limit the usefulness of conventional antiemetics in neurosurgical patients because such agents interfere with serial mental status examinations and lower the seizure threshold. Therefore, ondansetron may be preferable in this patient population. Two patients with head trauma and projectile vomiting were treated successfully with ondansetron following treatment failure with prochlorperazine. These represent the first reported cases of efficacious treatment with ondansetron in neurosurgical trauma patients. CONCLUSIONS: Ondansetron may be the preferred agent for controlling nausea and vomiting in patients with neurosurgical trauma. Controlled clinical trials are needed to evaluate its safety and efficacy in this patient population.

Accidental Falls↗
PubMedDate not supplied

Comparison of the efficacy of 2 mg versus 5 mg tropisetron in the management of post-operative nausea and vomiting.

A randomized, double-blind, placebo-controlled study was carried out to investigate the efficacy of 2 mg versus 5 mg tropisetron in the prevention of post-operative nausea and vomiting. Patients between 22 and 64 years old who were undergoing surgery under general anaesthesia and who had been classified according to the American Society of Anesthesiologists criteria with physical status I or II were included in this trial. Sixty female patients were recruited and divided into three groups (n = 20 in each group). Patients in group 1 received saline solution as control, whereas in groups 2 and 3, 2 mg or 5 mg tropisetron, respectively, was administered intravenously as a single dose during the induction of anaesthesia. The number of patients vomiting within the first 2 h following the operation was significantly less in groups 2 and 3 compared with that in group 1 (one of 20 for each of the groups 2 and 3 versus 12 of 20 in group 1). Three patients required rescue anti-emetic medication in each of the groups 2 and 3. In conclusion, 2 mg tropisetron appears to be equally as efficacious as 5 mg in preventing post-operative nausea and vomiting.

Adult↗
PubMed2006

A case report on a patient suffering from recurrent vomiting episodes, whose condition improved markedly during pregnancy and breast feeding.

BACKGROUND: The normal physiology of the gastrointestinal tract has been only cursorily examined. Consequently, the pathophysiology of disturbances of the gastrointestinal functions is poorly known. Recurrent vomiting is one of many functional conditions for which it is difficult to find an explanation and to treat. In the following a case is described of a patient presenting with recurrent vomiting episodes, whose condition improved spontaneously during pregnancy and breast feeding. CASE PRESENTATION: A woman with recurrent vomiting episodes over several years was examined by esophagogastroduodenoscopy. This showed a non-peristaltic ventricle. Treatment with the procinetic drug cisapride (Prepulsid) improved the peristalsis and reduced the symptoms. During pregnancy and breast feeding, she was free of symptoms, in spite of having discontinued her medication with cisapride (Prepulsid). CONCLUSION: The fact that the patient improved during pregnancy and breast feeding, would seem to indicate the involvement of factors in the physiology of pregnancy and breast feeding that are of importance for gastric motility. This deserves further investigation.

Acetylcholine↗
PubMed2004

Aprepitant for chemotherapy-induced nausea and vomiting.

Although the development of serotonin receptor antagonists has greatly improved treatment for chemotherapy-induced nausea and vomiting, patients receiving chemotherapy continue to experience this troublesome side effect. On March 26, 2003, the U.S. Food and Drug Administration approved aprepitant (Emend, Merck & Co., Inc., Whitehouse Station, NJ) for use in combination with standard antiemetic agents for acute and delayed nausea and vomiting with initial and repeat courses of highly emetogenic therapy. Aprepitant appears to provide superior control of acute and delayed emesis compared to standard antiemetic therapy. Aprepitant was well tolerated in phase III studies, with side effects similar to standard therapy. Healthcare providers need to be aware of potential drug interactions with aprepitant. Oncology nurses continue to play a key role in helping patients adhere to their antiemetic schedules, stressing the importance of prevention of nausea and vomiting.

Antiemetics↗
PubMed2001

Use of clinical pictures in the management of nausea and vomiting: a prospective audit.

This prospective audit aimed to evaluate a guideline for the management of nausea and vomiting in palliative care inpatients. Clinical pictures were used to guide diagnosis and treatment, with potentially reversible causes being addressed where appropriate. Over a 3-month period, 40 patient episodes occurred, all of which were included in the audit. The commonest clinical pictures were gastric stasis/outlet obstruction (35%) and chemical/metabolic (30%). Management according to the guideline was effective. Nausea was abolished in 28 of 34 cases (82%) and vomiting resolved completely in 26 of 31 cases (84%). Symptoms were totally controlled in a mean time of 3.4 days. Nausea and vomiting, although distressing symptoms, can be controlled in the majority of cases. Multi-centre prospective audit, using a standardized tool, may prove useful in allowing larger numbers of patients to be systematically analysed and individual centres to compare outcomes.

Adult↗
PubMed1981

Anorexia nervosa: some observations on "dieters" and "vomiters", cholesterol and carotene.

Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between "dieters' and "vomiters' were less pronounced than those reported elsewhere. However, the "vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown-Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.

Adolescent↗
PubMed1983

Binge-eating and self-induced vomiting in the community. A preliminary study.

This study examined by questionnaire the prevalence of binge-eating and self-induced vomiting among a sample of 369 consecutive attenders at a family planning clinic. 20.9 per cent reported current episodes of uncontrollable and excessive eating ('binges'), 2.9 per cent currently induced vomiting as a means of weight control; and 4.9 per cent reported using laxatives. Binge-eating and self-induced vomiting were strongly associated with disturbed attitudes to food, eating, body weight and shape; and with psychiatric disturbance. Menstrual dysfunction was not associated with either body weight or binge-eating; it was however associated with psychiatric state. Applying conservative rules, 1.9 per cent appeared to fulfil diagnostic criteria for the recently described syndrome bulimia nervosa.

Adolescent↗
PubMed1988

A randomized comparison of haloperidol plus dexamethasone versus prochlorperazine plus dexamethasone in preventing nausea and vomiting in patients receiving chemotherapy for breast cancer.

The antiemetic effectiveness of haloperidol plus dexamethasone was compared with that of prochlorperazine plus dexamethasone in a prospective study of patients receiving chemotherapy for breast cancer. Chemotherapy consisted of cyclophosphamide, doxorubicin or methotrexate, and fluorouracil in all patients. Patients who received the doxorubicin-containing combination experience significantly more nausea and vomiting than those who received the chemotherapy combination containing methotrexate. There was no significant difference between the two antiemetic regimens in the overall incidence of post-chemotherapy nausea and vomiting, but patients who received haloperidol and dexamethasone did have a lower incidence of severe vomiting. Neither regimen is highly effective, especially for the combination containing doxorubicin, and cannot be recommended as standard antiemetic therapy for this population of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Optimal combination therapy with tropisetron in 445 patients with incomplete control of chemotherapy-induced nausea and vomiting.

PURPOSE: This study evaluated tropisetron (Navoban; Sandoz Pharma, Basle, Switzerland)-based combination therapy in patients who had incomplete control of chemotherapy-induced nausea or vomiting when using tropisetron as a single antiemetic agent. PATIENTS AND METHODS: One thousand seventy-two patients, who were scheduled to receive at least two identical cycles of emetogenic chemotherapy, were treated with 5 mg tropisetron once daily in their first chemotherapy course. A 2 x 2 x 2 factorial design was used to evaluate three additional treatments to the recommended 5 mg once daily (intravenously [i.v.] on day 1; orally on days 2 through 6) tropisetron regimen during course 2 in those patients who had shown incomplete control of nausea and/or vomiting on any day of course 1. Four hundred forty-five patients were centrally randomized to receive, in addition, open-label dexamethasone (day 1, 0.2 mg/kg i.v.; days 2 through 6, 8 mg orally) and/or open-label alizapride (day 1, 100 mg i.v. and 4 x 50 mg orally; days 2 through 6, 4 x 50 mg orally) and/or double-blind tropisetron (ie, doubling the dose to 10 mg once daily) or corresponding placebo. RESULTS: Complete response rates (no nausea and no vomiting) were 72% for day 1 and 48% for days 1 through 6 of course 1. During course 2, more complete responders were observed when dexamethasone was added, both for day 1 (76% v 66%, P = .020) and for days 1 through 6 (50% v 34%, P = .0004). A moderate increase in the complete response rate was seen with the addition of conventional-dose alizapride (day 1, 75% v 68%, P = .14; days 1 through 6: 47% v 37%, P = .041). Doubling the dose of tropisetron did not change the complete response rate. CONCLUSION: The addition of dexamethasone significantly increases the complete response rate of both acute and delayed emesis in patients who have incomplete disease control with tropisetron alone.

Administration, Oral↗
PubMed2005

Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy.

PURPOSE: This is the first study in which the NK(1)-receptor antagonist, aprepitant (APR), was evaluated for the prevention of chemotherapy-induced nausea and vomiting (CINV) with moderately emetogenic chemotherapy. PATIENTS AND METHODS: Eligible breast cancer patients were naive to emetogenic chemotherapy and treated with cyclophosphamide +/- doxorubicin or epirubicin. Patients were randomly assigned to either an aprepitant regimen (day 1, APR 125 mg, ondansetron (OND) 8 mg, and dexamethasone 12 mg before chemotherapy and OND 8 mg 8 hours later; days 2 through 3, APR 80 qd) [DOSAGE ERROR CORRECTED] or a control regimen (day 1, OND 8 mg and dexamethasone 20 mg before chemotherapy and OND 8 mg 8 hours later; days 2 through 3, OND 8 mg bid). Data on nausea, vomiting, and use of rescue medication were collected with a self-report diary. The primary efficacy end point was the proportion of patients with complete response, defined as no vomiting and no use of rescue therapy, during 120 hours after initiation of chemotherapy in cycle 1. The secondary end point was the proportion of patients with an average item score higher than 6 of 7 on the Functional Living Index-Emesis questionnaire. RESULTS: Of 866 patients randomized, 857 patients (99%) were assessable. Overall complete response was greater with the aprepitant regimen than with the control regimen (50.8% v 42.5%; P = .015). More patients in the aprepitant group reported minimal or no impact of CINV on daily life (63.5% v 55.6%; P = .019). Both treatments were generally well tolerated. CONCLUSION: The aprepitant regimen was more effective than the control regimen for prevention of CINV in patients receiving both an anthracycline and cyclophosphamide.

Adult↗
PubMed2003

A comparison of the costs and efficacy of ondansetron and dolasetron in the prophylaxis of postoperative vomiting in pediatric patients undergoing ambulatory surgery.

UNLABELLED: Postoperative vomiting (POV) after ambulatory surgery remains a major problem. We designed this study to determine the smallest dose of dolasetron equivalent to the Food and Drug Administration approved dose of ondansetron 100 micro g/kg IV, for the prophylaxis of POV in children undergoing surgery. In this double-blinded controlled study, 204 healthy ASA I-II children aged 2-12 yr, undergoing superficial ambulatory (day-case) surgery, were randomized to receive either ondansetron 100 micro g/kg IV, or dolasetron 45, 175, 350, or 700 micro g/kg IV during a standardized perioperative regimen. The primary end-point was the incidence of complete response, defined as the absence of POV symptoms. Costs were calculated from the perspective of the hospital using a previously described model. The incidence of early (0-6 h) and 24-h emesis was more frequent in the dolasetron 45 micro g/kg group compared with the dolasetron 350 and 700 micro g/kg groups and with the ondansetron group. Repeated POV occurred more often when dolasetron was used in a dose <350 micro g/kg. There were no significant differences in emesis rates between the dolasetron 175, 350, and 700 micro g/kg groups or between these groups and the ondansetron 100 micro g/kg group. The smallest dose of dolasetron with acceptable equivalent efficacy and patient satisfaction scores to ondansetron 100 micro g/kg was 350 micro g/kg. Institutional costs for managing POV were less with dolasetron 350 micro g/kg than with ondansetron. IMPLICATIONS: This randomized double-blinded dose-ranging study concluded that dolasetron, 350 micro g/kg IV, was the smallest dose that provided acceptable equivalent efficacy and patient satisfaction scores to ondansetron, 100 micro g/kg IV, for the prophylaxis of postoperative vomiting in children undergoing outpatient surgery. However, with this dose, the costs to the institution for managing postoperative vomiting were less.

Ambulatory Surgical Procedures↗