Articles: nausea.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A single-blind comparison of intravenous ondansetron, a selective serotonin antagonist, with intravenous metoclopramide in the prevention of nausea and vomiting associated with high-dose cisplatin chemotherapy.
Ondansetron (GR 38032F), a selective antagonist of serotonin subtype 3 receptors, is effective in the prevention of emesis associated with cisplatin as well as other chemotherapeutic agents. In this randomized, single-blind, multicenter, parallel group study, we compared the efficacy and safety of intravenous (IV) ondansetron with IV metoclopramide in the prevention of nausea and vomiting associated with high-dose (greater than or equal to 100 mg/m2) cisplatin chemotherapy. Three hundred seven patients receiving their first dose of cisplatin, either alone or in combination with other antineoplastic agents, were randomized to receive ondansetron 0.15 mg/kg IV every 4 hours for three doses or metoclopramide 2 mg/kg IV every 2 hours for three doses, then every 3 hours for three additional doses. ⋯ Adverse events occurred in 48% of patients receiving ondansetron and 69% of those receiving metoclopramide (P less than .001). Akathisia and acute dystonic reactions occurred only on metoclopramide; headache (controlled with acetaminophen) was significantly more frequent with ondansetron. Ondansetron is more effective, produces fewer adverse events, and is easier to administer than metoclopramide for the prevention of emesis associated with high-dose cisplatin chemotherapy.
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Complications during spinal anesthesia were studied prospectively in 1881 patients. Twenty-six percent of the patients suffered from one or more complications. The most common complications were hypotension (16.4%) and bradycardia (8.9%). ⋯ Higher peak sensory level significantly increased the risk for hypotension (p less than 0.0001), bradycardia (p less than 0.0001) and nausea (p less than 0.0001). Female patients suffered significantly more hypotension (p less than 0.001), nausea (p less than 0.001) and vomiting (p less than 0.001) than males. Cementation of prosthesis and deflation of the leg tourniquet were other risk factors demonstrated in this study.
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Clinical Trial Controlled Clinical Trial
Does the duration of N2O administration affect postoperative nausea and vomiting?
Nausea and vomiting are the most frequent postoperative complications in the ambulatory surgical setting. In the present study, data were obtained from 184 adult ambulatory cosmetic surgery patients to determine if the use of nitrous oxide (N2O) was associated with an increased incidence of postoperative nausea and/or vomiting (PNV). Anesthesia was induced with thiopental and maintained with an opioid (fentanyl or sufentanil) and isoflurane with or without N2O. ⋯ The major finding was that the incidence of PNV was directly related to the duration of anesthesia in the patients who received N2O, but not in those who were N2O-free. Anesthesia times and the percentages of patients who exhibited PNV in the N2O-free and N2O-treated groups, respectively, were: (1) less than 1 hour, 0% and 6.3%; (2) between 1.0 and 1.9 hours, 35.3% and 36.8%; (3) between 2.0 and 2.9 hours, 24.2% and 66.7% (p = .06); (4) between 3.0 and 5.3 hours, 35% and 100% (P less than .05). Thus, avoidance of N2O in ambulatory cosmetic surgery cases lasting 3, and quite probably 2 or more hours in which general anesthesia is maintained with a synthetic opioid and isoflurane appears to reduce the likelihood that these short-stay patients will experience PNV.
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A recent report suggested that more than 50% of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. ⋯ Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31 +/- 24 on Day 6 to 24 +/- 19 on day of death (DOD) (p less than 0.05); nausea from 19 +/- 18 on Day 6 to 13 +/- 9 on DOD (p less than 0.01); drowsiness from 51 +/- 28 on Day 6 to 85 +/- 45 on DOD (p less than 0.001); symptom distress score from 49 +/- 11 on Day 6 to 52 +/- 9 on DOD (p less than 0.01). On the day of admission (DOA), 69% of VAS were done by the patient and 28% by the nurse as compared to 8% by the patient and 90% by the nurse on DOD. Level of consciousness on DOA was alert (72%), drowsy (28%), unresponsive (0%) and by DOD was alert (2%), drowsy (41%), unresponsive (57%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Cahiers d'anesthésiologie · Jan 1991
Review[Secondary effects of opioids administered by the regional route].
The administration of narcotics in the subarachnoid or the epidural space is gaining acceptance for postoperative pain relief. However, the potential side effects of intrathecal and epidural use of opioids are the following: early and late respiratory depression, pruritus, nausea and vomiting, urinary retention. ⋯ Naloxone can be used to reverse the depression. Pruritus can occur in 10 to 30% of patients receiving morphine; 10 to 30% nausea and vomiting, and urinary retention occurs in 20 to 50% of patients.