Articles: nausea.
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In an editorial, Kapur [4] described perioperative nausea and vomiting as the big "little problem following ambulatory surgery." In contrast to the attitudes of some physicians, patients put a high value on freedom from nausea and emesis in the postoperative period and are willing to accept some pain and drowsiness as the cost of controlling PONV [85]. Until recently, there had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, the introduction of the IV anesthetic agent propofol and of the NSAID ketorolac, plus abandonment of the policy of insisting that patients drink before discharge, appear to have contributed to a recent decline in the incidence of emesis. ⋯ Further research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. Improvements in antiemetic therapy could have a major impact for surgical patients, particularly those undergoing ambulatory surgery. Just as pain is no longer considered an unavoidable part of the postoperative experience, so should nausea and vomiting be considered an avoidable side effect.
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Oncology nurses and patients identify nausea and vomiting as the two most distressing side effects of chemotherapy. The onset and duration of nausea and vomiting in patients receiving chemotherapy may vary. Inadequate control of emesis in the first 24 h following chemotherapy can lead to anticipatory nausea and vomiting and poor control in subsequent cycles of treatment. ⋯ Assessment should include nausea as a separate phenomenon that may occur in the absence of vomiting and can be equally, if not more, distressing. Objective measures are suitable for the assessment of vomiting, but are not available for assessment of nausea because it is a subjective phenomenon. The purpose of this article is to present evidence supporting the idea that patient reporting using a four-point scale may be a reliable indicator of the degree of nausea and antiemetic efficacy.
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Granisetron is a selective serotonin3 (5-hydroxytryptamine3, 5-HT3) receptor antagonist which has significant antiemetic activity against chemotherapy-induced nausea and vomiting. A single prophylactic intravenous dose is sufficient to control acute nausea and vomiting in approximately 60 to 70% of patients. In comparative studies, the acute antiemetic efficacy of granisetron is equivalent or superior to that of traditional antiemetic regimens even in patients receiving highly emetogenic cisplatin-containing chemotherapy. ⋯ Thus, recent data confirm that granisetron is an effective and well tolerated agent for the prophylactic treatment of chemotherapy-induced acute nausea and vomiting, with efficacy equivalent or superior to that of other currently available agents. It has a promising role to play in paediatric oncology, and is an effective agent in controlling radiotherapy-induced acute emesis. Granisetron offers comparable or superior efficacy in controlling acute nausea and vomiting with a much simpler dosage regimen than that of traditional antiemetic regimens.
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Ann Acad Med Singap · Nov 1994
ReviewRecent advances in the understanding and management of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) is a common distressing complication of surgery and anaesthesia. The multifactorial aetiology of PONV gives rise to an incidence that varies widely among different patient groups. ⋯ Current research is concentrated on a new class of drugs, the serotonin (5-HT3) receptor antagonists. This review summarizes the experience with these drugs and other recent advances in PONV.
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Nausea and vomiting are frequent problems in the postoperative period. The introduction of 5-HT3 receptor antagonists has stimulated interest and research in this area. ⋯ The choice of antiemetic drugs for treatment and prophylaxis should be guided by consideration of effect mechanism, side-effects, clinical documentation and total costs. No single drug is fully effective and combination therapy should be considered in resistant cases.