ABSTRACT
Nausea and vomiting are the most common complications after minor head trauma that increases the risk of intracranial pressure rising. Therefore, the present study was aimed to compare the antiemetic effects of metoclopramide and ondansetron in the treatment of post-traumatic nausea and vomiting. The study was a controlled, randomized, double blind clinical trial, which was conducted in the first 6 months of 2014 in emergency department Al-Zahra and Kashani Hospitals in Isfahan, Iran. The patients with minor head trauma associated with nausea and vomiting were randomly divided into 2 groups: treatment with metoclopramide [10mg/2ml, slow injection] and treatment with ondansetron [4mg/2ml, slow injection]. The comparison between the 2 groups was done regarding antiemetic efficacy and side effects using SPSS 21 statistical software. 120 patients with minor head trauma were distributed and studied into two groups of 60 patients [mean age 35.6 +/- 14.1 years; 50.0% male]. Administration of both ondansetron and metoclopramide significantly reduced the severity of nausea [P<0.001]. Changes in the severity of nausea in both groups before and after the treatment revealed that nausea had been decreased significantly in both groups [P < 0.001]. The incidence of fatigue [p=0.44], headache [p=0.58] and dystonia [p=0.06] had no significant difference in the two groups but the incidence of drowsiness and anxiety in the metoclopramide group was significantly higher [P < 0.001]. The present study indicated that the treatment effectiveness of ondansetron and metoclopramide are similar. However, incidence of drowsiness and anxiety in the metoclopramide was considerably higher. Since these complications can have adverse effects on the treatment of patients with brain injury, it is suggested that it may be better to use ondansetron in these patients
ABSTRACT
The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia [PSA] to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced until now. The aim of the present study was comparison of oral chloral hydrate [OCH] and rectal sodium thiopental [RST] in pediatric PSA. In the present randomized clinical trial, 2-6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH [50mg/kg] and RST [25mg/kg] were prescribed and a trained nurse recorded the time from drug prescription to receiving the conscious sedation [onset of action], the total period which the patient has the Ramsay score>/=4 [duration of action], and adverse effect of agents. Mann-Whitney U test and chi-squared test, and Non-parametric analysis of covariance [ANCOVA] were used for comparisons. One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure [p<0.001]. The onset of action in OCH and RST groups were 24.5 +/- 6.1and 28.7 +/- 5.2 minutes, respectively [p<0.001]. Duration of action in OCH and RST groups were 12.9 +/- 2.8 minutes and 13.7 +/- 2.6 minutes, respectively [p=0.085]. Non-parametric ANCOVA revealed that only diastolic blood pressure was affected by drug prescription [p=0.001]. In 11[15.7%] patients in RST group, diarrhea was observed during 24 hours [p=0.001]. Oxygen desaturation was observed only in two patients, both in OCH group. Each of the sedative has advantages and disadvantages that should be considered when selecting one for inducing short-term sedation. It seems that rectal sodium thiopental and oral chloral hydrate are equally effective in pediatric PSA and based on patient's condition we can administrate one of these agents