Comparison of Intravenous Ramosetron and Ondansetron as Prophylaxis for Postoperative Nausea and Vomiting following General Anesthesia

Objective: To compare the efficacy and side effects of 5HT3 antagonists, ramosetron, and ondansetron as prophylaxis for postoperative nausea and vomiting (PONV) following general anesthesia. Materials and Methods: One hundred and ten patients of the American Society of Anesthesiology Grade I–II, between the age group of 18 to 60 years weighing 40 to 70 kg, undergoing general anesthesia were studied. Group 1 received ramosetron 0.3 mg intravenous (IV) and Group 2 received ondansetron 8 mg IV 15 min before the end of surgery. The incidence of PONV, need for rescue antiemetic, and side effects were evaluated in both the groups. QTc interval prolongation was also evaluated in both the groups by taking electrocardiograms at regular intervals. Results: This study showed that there was no statistically significant difference in the incidence of PONV between the ondansetron group and the ramosetron group during the first 24 h after surgery. For PONV score of ?2 during the first 6 h, the incidence was 3.59% and 1.81% for ramosetron and ondansetron, respectively, and during 6–24 h, the incidence was 1.81% for both the drugs. Conclusion: IV ramosetron 0.3 mg is as effective as IV ondansetron 8 mg in preventing PONV in patients undergoing general anesthesia

Terapia combinada en la profilaxis de las náuseas y vómitos postoperatorios en cirugía laparoscópica / Combined therapy and prophylaxis in postoperative nausea and vomiting in laparoscopic surgery

Introducción: Las náuseas y vómitos postoperatorios representan un problema frecuente tanto para el paciente como para el médico anestesiólogo. Se estima que la incidencia está en un 25 a 30 por ciento de los pacientes postoperados. Objetivo: Profundizar en los conocimientos relacionados con la terapia combinada en la profilaxis de las náuseas y vómitos postoperatorios. Métodos: Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Desarrollo: La naturaleza multifactorial de las náuseas y vómitos postoperatorios requiere de un enfoque multimodal para su tratamiento, el cual debe ser profiláctico más que terapéutico, con el objetivo de minimizar el riesgo. No es factible modificar sustancialmente las variables dependientes del paciente y de la intervención quirúrgica, pero se puede influir directamente sobre las anestésicas. En varios estudios se han identificado los diferentes factores de riesgo para náuseas y vómitos postoperatorios y a partir de estos se han desarrollado modelos predictivos que permiten evaluar la probabilidad del evento. Conclusiones: Las náuseas y vómitos postoperatorios constituyen un fenómeno frecuente en el postoperatorio. Para su profilaxis es recomendable el uso de terapias combinadas (antidopaminérgicos, antihistamínicos, anticolinérgicos, antagonistas de la serotonina, esteroides y antagonistas de la neurokinina-1) dado su componente multifactorial. Esta forma de afrontar dicho problema permite disminuir la frecuencia de estos síntomas, las complicaciones postoperatorias y facilitar la recuperación más inmediata del paciente(AU)

ABSTRACT Introduction: Postoperative nausea and vomiting represent a frequent problem for both the patient and the anesthesiologist. It is estimated that the incidence of these are present in 25-30 percent of postoperative patients. Objective: To go deepen in the knowledge related to physiopathology and combination therapy in the prophylaxis of postoperative nausea and vomiting. Method: A bibliographic review was made of the articles published in the Pubmed, Scielo, Medline and Cochrane data bases, related to the topic, belonging to authors dedicated to the study of this problem. Development: The multifactorial nature of postoperative nausea and vomiting requires a multimodal approach to its treatment, which should be prophylactic rather than therapeutic, with the objective of minimizing risk. It is not reasonable to modify the dependent variables of the patient and of the surgical intervention, but it is possible to directly influence the anesthetics. In several studies, the different risk factors for PONV have been identified and, from these, predictive models have been developed to evaluate the probability of the event. Conclusions: postoperative nausea and vomiting are a frequent phenomenon in the postoperative period. For its prophylaxis the use of combination therapies (antidopaminergic, antihistaminic, anticholinergic, serotoninantagonists, steroids and neurokinin-1 antagonists) is recommended, givenits multifactorial component. This way of dealing with this problema allows us to reduce the frequency of these symptoms, postoperative complications and facilitate the patient's most immediate recovery(AU)

Study on the antiemetic property of methanolic stem extract of Swertia chirata using chick emesis model

Background: Swertia chirata has been an important herb known for centuries for its various medicinal uses and bitter taste. The stem of the plant is used as a traditional medicine in an array of diseases including the treatment of vomiting. Therefore, the study was undertaken to explore the possible antiemetic property of methanolic extract of its stems by using chick emesis model.Methods: 25 male chicks of four days old weighing 25 to 35 grams were fed with copper sulfate anhydride at 50mg/kg body weight to induce emesis. The chicks were grouped into 5 with each group bearing 5 chicks (n=5). Group I (control) received 10ml/kg normal saline; group II (standard) received 150mg/kg chlorpromazine; group III (experimental-1), group IV (experimental-2) and group V (experimental-3) received 50, 100 and 150mg/kg respectively of the extract. All doses are given intraperitoneally. Assessment of antiemetic activity was done by calculating the percentage of inhibition of the number of retches in the chicks.Results: All the three doses of the extract showed antiemetic activity. The dose of 50 mg/kg showed activity comparable to chlorpromazine, while dose of 100 mg/kg and 150mg/kg showed greater activity than chlorpromazine. Highest antiemetic activity (79.26% inhibition) was shown by a dose of 150mg/kg and lowest (42.22% inhibition) by 50mg/kg.Conclusions: Methanolic extract from the stems of Swertia chirata has excellent anti-emetic property which can be further investigated for development of potential antiemetic medicines.

Trends in the Prevalence of Drug-Induced Parkinsonism in Korea

PURPOSE: Discontinuation of offending drugs can prevent drug-induced parkinsonism (DIP) before it occurs and reverse or cure it afterwards. The aim of this study was to investigate the prevalence of DIP and the utilization of offending drugs through an analysis of representative nationwide claims data. MATERIALS AND METHODS: We selected DIP patients of ages ranging from 40 to 100 years old with the G21.1 code from the Korean National Service Health Insurance Claims database from 2009 to 2015. The annual standardized prevalence of DIP was explored from 2009 to 2015. Trends were estimated using the compound annual growth rate (CAGR) and the Cochran-Armitage test for DIP over the course of 6 years. Additionally, the utilization of offending drugs was analyzed. RESULTS: The annual prevalence of DIP was 4.09 per 100000 people in 2009 and 7.02 in 2015 (CAGR: 9.42%, p<0.001). Levosulpiride use before and after DIP diagnosis showed a clear trend for decreasing utilization (CAGR: −5.4%, −4.3% respectively), whereas the CAGR for itopride and metoclopramide increased by 12.7% and 6.4%, respectively. In 2015, approximately 46.6% (858/1840 persons) of DIP patients were prescribed offending drugs after DIP diagnosis. The most commonly prescribed causative drug after DIP diagnosis was levosulpiride. CONCLUSION: The prevalence of DIP has increased. To prevent or decrease DIP, we suggest that physicians reduce prescriptions of benzamide derivatives that have been most commonly used, and that attempts be made to find other alternative drugs. Additionally, the need for continuing education about offending drugs should be emphasized.

Mechanism of Dichroa Alkali Salt Inducing Vomiting Based on Pica in Mice / 中国实验方剂学杂志

Objective: To study the possible mechanism of dichroa alkali salt (DAS) in inducing vomiting. Method: Mice pica model was used to observe the antagonistic effect of the three different kinds of antiemetic drugs[dopamine receptor antagonist metoclopramide, 5-hydroxytryptamine 3 (5-HT3) receptor antagonist ondansetron and neurokinin-1 receptor antagonist aprepitant] on body mass, food intake, kaolin consumption, diarrhea and death induced by DAS to preliminarily clarify the possible pathogenic pathway of DAS. Then, the expression of 5-HT and substance P(SP) in ileum and medulla of mice induced by DAS alone at different time points was detected by enzyme-linked immunosorbent assay to confirm whether DAS could affect the changes of these two neurotransmitters. Result: After treatment with ondansetron and aprepitant, DAS-induced reduction in food intake of mice was significantly improved on the 4th day after continuous administration and on the 1st day after drug administration (Prd day after administration, DAS-induced body mass loss of mice was significantly improved (PConclusion: The mice pica model can be used to effectively characterize DAS-induced vomiting. DAS-induced pica in mice may be associated with the increase of 5-HT and SP in ileum and medulla. Ondansetron and aprepitant can effectively antagonize DAS-induced pica in mice.

Comparison of Sugammadex and Neostigmine on First Spontaneous Breathing and Adverse Effects for Laparoscopic Cholecystectomy

OBJECTIVE: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. METHODS: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). RESULTS: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p < 0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p < 0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p < 0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p < 0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p < 0.05). CONCLUSION: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.

Preliminary study of antiemetic components in Euodia rutaecarpa based on spectrum-effect correlation analysis / 药学学报

This study was designed to screen the antiemetic components of Euodia rutaecarpa, and elucidate its material basis on the spectrum-effect correlation analysis. The UHPLC-Q-TOF/MS (UHPLC-quadrupole time-of-flight mass spectrometry) technology was used to obtain the fingerprint of Euodia rutaecarpa extracts. The perfusion of copper sulfate was used as a model to study the antiemetic effect by vomiting. The orthogonal partial least squares (OPLS) method was used to analyze the spectrum-effect relationship. The results indicated the following compounds were the potential antiemetic components such as rutin, limonin, narcissoside, chrysoeriol-7-O-rutinoside, hyperoside, isorhamnetin-3-O-β-D-galactoside, 1-methyl-2-undecyl-4(1H)-quinolone, 1-methyl-2-[(Z)-4-nonenyl]-4(1H)-quinolone. This study provides the experimental basis in use of Euodia rutaecarpa in the future, and provides the research methods and ideas for the similar study on the pharmacodynamic material basis of traditional Chinese medicine.

Observation of effects of mannitol combined with multimodal-antiemetic therapy in patients of postoperative nausea and vomiting undergoing thyroidectomy / 临床麻醉学杂志

Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative dizziness,headache,nausea and vomiting (PONV) in patients undergoing thyroidectomy.Methods One hundred patients (39 males and 61 females,ASA physical status Ⅰ or Ⅱ) scheduled for thyroidectomy were randomly divided into two groups according to random number table: control group (group C) and multimodal-antiemetic therapy group (group M).Two groups received total intravenous anesthesia (TIVA) with propofol and remifentanil.Prophylactic dexamethasone 10 mg were given after anesthesia induction and palonosetron hydrochloride 0.25 mg was used 30 min before the end of surgery in both groups.Mannitol 2 ml/kg in group M and the same amount of normal saline in group C were given 30 min before the end of surgery.The incidence of dizziness,headache and PONV were observed for 24 h in two groups.Results The incidence of headache was 5 cases (10%)and PONV was 5 cases (10%) in group M,which were respectively significantly lower than that of group C of 15 cases (30%) and 12 cases (24%) in 24 h after surgery (P<0.05).The additional antiemetic therapy for 24 h after surgery in group M of 2 cases (4%) was significantly lower than that of group C of 9 cases (18%) (P<0.05).Conclusion The multimodal-antiemetic therapy: prophylactic dexamethasone,palonosetron hydrochloride and mannitol were used 30 min before the end of surgery could significantly reduce the incidence of dizziness,headache and PONV after thyroidectomy.

Antiemetic Effect of Ethyl Acetate Extract with Ethanol Extraction of Galangal in Allotriophagic Kaolin-induced Model Rats / 中国药师

Objective: To study the antiemetic effect of the ethyl acetate extract with ethanol extraction of Galangal (hereinafter referred to as galangal extract) in allotriophagic Kaolin model rats.Methods: The rats were administered respectively with chemical drug cisplatin and apomorphine, and received the rotation stimulation as well.Three types of allotriophagic Kaolin models were established, and apomorphine, ondansetron and metoclopramide were used as the control drugs.The experimental rats were divided into 3 groups at low, medium and high dose of Galangal extract with prophylactic effect.The antiemetic effect was observed after the treatment.Results: Chemical drug cisplatin (3.0 mg·kg-1, intraperitoneal injection) and apomorphine (3.2 mg·kg-1,subcutaneous injection) and the rotation stimulation (centrifugal force of 3.4×g,60min) could induce allotriophagic vomiting in rats.The galangal extract at low (1 500 mg·kg-1), medium (4 500 mg·kg-1) and high (9 000 mg·kg-1) dose all fail to effectively inhibit the allotriophagic Kaolin behavior of rats caused by cisplatin, apomorphine and rotation(P>0.05).Conclusion: Galangal extract can not effectively inhibit the vomiting of allotriophagic Kaolin model rats.Probably, there is no correlation between the pharmacological effects of galangal extract and substance P, 5-hydroxytryptamine, dopamine as well as receptive zone of chemical vomiting inhibition.

Effect of capsicum plaster at the P6 acupoint on postoperative nausea and vomiting in patients undergoing endoscopic sinus surgery

BACKGROUND: We evaluated the efficacy of capsicum plaster, applied to the Chinese acupuncture point (acupoint) Pericardium 6 (P6), in reducing postoperative nausea and vomiting (PONV) in patients who underwent endoscopic sinus surgery (ESS). METHODS: One hundred and fifty patients scheduled for ESS were randomly placed in one of 3 groups. Each group had 50 patients. Inactive tape was affixed at both P6 acupoints and both shoulders in the control (placebo) group. Capsicum plaster was affixed at both P6 acupoints and inactive tape was affixed at both shoulders in the capsicum plaster (P6) group. Capsicum plaster was affixed at both shoulders and inactive tape at both P6 acupoints in the sham group. Plasters and tapes were affixed before the induction and removed 8 hours after surgery. RESULTS: The incidence of PONV and requirement for antiemetics were significantly lower in the P6 group than in the control and sham groups during the 24 hours after surgery. At postoperative 0-24 hour, nausea was 42% in the control group, 2% in the P6 group, and 38% in the sham group. Postoperative vomiting was 28%, 0% and 26%, respectively, and the use of antiemetics was 34%, 0% and 32%, respectively. CONCLUSIONS: Stimulation of the P6 acupoint with capsicum plaster is effective for preventing PONV at postoperative 0-24 hour in patients undergoing ESS.

Antiemetic activity of effective extract and bioactive compounds in ginger / 中国中药杂志

To investigate the antiemetic effect of the active extract (ginger ether extract, GEE) and its bioactive compounds in ginger, the pica vomiting model in rats and the gastric emptying model in mice were used to observe the antiemetic effect of GEE in cisplatin-induced pica and gastric emptying, and the main components in GEE were detected by RP-HPLC; in vitro, the antagonist effect of GEE and the four components in it were explored by the contraction of guinea-pig ileum induced by SR57227A and carbachol. The results showed that the amount of Kaolin ingested by rats were declined significantly in all the three groups of GEE (25,50,100 mg•kg⁻¹) (P<0.01), while cisplatin-induced gastric emptying in mice was also suppressed in all the three groups (P<0.01), and 6-gingerol, 8-gingerol,10-gingerol and 6-shogaol were found mainly in GEE by RP-HPLC; the maximum contraction of isolated guinea-pig ileum could be reduced by addition of GEE (2.3, 4.6, 11.5 mg•L⁻¹), 6-gingerol,8-gingerol,10-gingerol or 6-shogaol (1, 2, 5 μmol•L⁻¹) when the concentration of SR5727A was 1×10⁻⁵ mol•L⁻¹ and that of carbachol was 1×10⁻⁴ mol•L⁻¹ (P<0.05, P<0.01). In conclusion, 5-HT3 and M3 receptors could be antagonized by GEE and its bioactive compounds 6-gingerol, 8-gingerol, 10-gingerol and 6-shogaol, which may be correlated with the antiemetic mechanism of ginger maybe related to it.

Tropisetron for the prevention of postoperative nausea and vomiting：a Meta-analysis / 重庆医学

Objective To evaluate the efficacy and safety of tropisetron for the prevention of postoperative nausea and vomi -ting (PONV) after general anesthesia .Methods We searched the PubMed ,EBSCO ,Cochrane ,CNKI and Weipu database to identi-fy randomized controlled trials (RCT ) about tropisetron in preventing PONV after general anesthesia .The methodological quality of the included RCT was assessed and data were extracted .The meta-analyses were performed by Rev Man5 .0 software .Results A total of 18 RCT met the inclusion criteria ,involving 2 901 patients .All RCT were randomized double-blind experiments .The results of meta-analyses showed that :(1)tropisetron could significantly decrease the incidence of PONV after general anesthesia ,[OR =0 .43 ,95% CI(0 .33 - 0 .57)] ,the efficacy in later period [OR = 0 .41 ,95% CI(0 .25 - 0 .65)] was better than that in earlier period [OR = 0 .66 ,95% CI(0 .44 - 0 .98)] ;(2)compared with tropisetron ,the combination of tropisetron and dexamethasone could signifi-cantly decrease the incidence of PONV [OR = 0 .37 ,95% CI(0 .22 - 0 .64)] ;(3)compared with granisetron or ondansetron ,tropise-tron could not significantly decrease the incidence of PONV ,the OR was [OR = 1 .08 ,95% CI(0 .68 - 1 .73)] and [OR = 0 .77 ,95%CI(0 .27 - 2 .21)] respectively ;(4)compared with dexamethasone ,tropisetron could not significantly decrease the incidence of PONV [OR = 1 .06 ,95% CI(0 .49 - 2 .30)] .Conclusion Tropisetron can significantly decrease the incidence of PONV after general anesthesia .It has also the advantage of decreasing incidence of the incidence of PONV combined with other non-5 HT-3 receptor in-hibitor such as dexamethasone .

Clinical Observation of Acupoint Application of Antiemetic Cream in the Treatment of Chemotherapy-in-duced Nausea and Vomiting / 中国药房

OBJECTIVE:To observe the clinical efficacy of acupoint application of antiemetic cream in the treatment of che-motherapy-induced nausea and vomiting. METHODS:90 cases of non-small cell lung cancer(NSCLC)(stage Ⅱ to Ⅲ)treated by chemotherapy(taxol+cisplatin)were randomly divided into antiemetic cream group,Weifuan group and control group,with 30 cas-es in each groupby drawing lots. Control group was given intravenous injection of ondansetron hydrochloride 8 mg 30 min before chemotherapy;antiemetic cream group was additionally given acupoint application of antiemetic cream 30 min before medication on first-forth day on the basis of control group;Weifuan group was additionally given acupoint injection of metoclopramide(brand name:Weifuan) 30 min before medication on first-forth day on the basis of control group. The clinical efficacy of 3 groups were observed during and 3 days after chemotherapy. RESULTS:After chemotherapy,the total control rates of antiemetic cream group (93.33%)and Weifuan group(90.00%)were apparently higher than the control group(66.67%),with statistical significance(P0.05). However,8 patients had obvi-ously pain at the injection site in Weifuan group,but tolerated to the drugs basically. CONCLUSIONS:The acupoint application of antiemetic cream combined with intravenous injection of ondansetron is effective and easy to operate in the treatment of nausea and vomiting induced by chemotherapy for stage Ⅱ to Ⅲ of NSCLC without pain,scar and sequela,and easy to be accepted by patients.

Pharmaceutical Care in the Management of Nausea and Vomiting Induced by Adjuvant Chemotherapy for a Postoperative Patient with Gastric Cancer / 医药导报

Objective To provide reference for clinical pharmacist participating in management of nausea and vomiting induced by tumor chemotherapy. Methods The process of pharmaceutical care for a patient with severe vomiting caused by adjuvant chemotherapy after gastric cancer operation was described. Antiemetic application and drug adverse reactions were analyzed. A new treatment plan was given by clinical pharmacist. Results The suggestions were adopted by clinician. The vomiting was controlled and drug adverse reactions were dealt with. Conclusion To reduce the risk and improve the income of antiemetic,clinical pharmacists should pay more attention to clinical practice guideline,drug interaction and adverse reactions, provide the most suitable suggestions for clinicians according to pharmacology and evidence-based medicine.

Clinical trial of electronic antiemetic acupuncture in combination with palonosetron in prevention of tardive vomiting induced by highly emetogenic chemotherapy / 重庆医学

Objective To explore the effect of electronic antiemetic acupuncture in combination with palonosetron in preven‐ting tardive vomiting induced by highly emetogenic chemotherapy for cancer patients .Methods One hundred and twenty cancer pa‐tients undergoing highly emetogenic chemotherapy were divided into observation group and control group(n=60) .The observation group was treated with electronic antiemetic acupuncture in combination with palonosetron and the control group was treated with palonosetron .The different effects against nausea and vomiting between these two groups were evaluated after 24 hours of the chemotherapy .Results Response rate of improvement of nausea for the observation group and control group from the 2nd day to the 8th day were 90 .0% vs 71 .7% ,68 .3% vs 41 .7% ,60 .0% vs 36 .7% ,65 .0% vs 40 .0% ,80 .0% vs 58 .3% ,91 .7% vs 81 .7% , 98 .3% vs 96 .6% .From the 2nd day to the 6th day there were statistical difference of the two groups(P0 .05) .Response rate of prevention of vomit for the observation group and control group from the 2nd day to the 6th day were 98 .3% vs 88 .3% , 81 .7% vs 65 .0% ,75 .0% vs 51 .7% ,90 .0% vs 70 .0% ,98 .3% vs 88 .3% ,and there were statistical difference of the two groups (P<0 .05) .The prevention of vomiting in the 7th day and 8th day of the two groups were 98 .3% vs 86 .7% ,98 .3% vs 88 .3% , there were also statistical difference(P<0 .05) .Conclusion The treatment of electronic antiemetic acupuncture in combination with palonosetron have greater effect in prevention of tardive vomiting than palonosetron caused by highly emetogenic chemotherapy .It can be used conventionally in the chemotherapy .

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study .

Background: Use of anti-emetic drugs in pediatric population is often warranted, but choice of drug remains questionable within pediatricians. Objective of current study is: to study prescribing pattern and to calculate cost of antiemetic drug therapy in pediatric wards. Methods: A prospective, observational study was conducted in pediatric wards of a tertiary care hospital of over 14 month’s duration. Institutional ethics committee approval was obtained and written informed consent of parents/guardians was taken. Data of any pediatric patient receiving anti-emetic agent were included in the study. Results: A total of 218 prescriptions were collected. Mean age of patients was 4.39±3.16 (range 4 months to 12 years). Gastroenteritis was the most frequently diagnosed disease in 137(63%) patients. Domperidone was prescribed in 52.4% and ondansetron in 47.6% children. Oral liquid dosage formulation was prescribed in 109 (48.4%) followed by solid dosage form 47 (20.9%). Mean cost of domperidone therapy was 25.34±6.55 INR and for ondansetron it was 36.62±17.94 INR. Conclusions: Gastroenteritis was most frequent indication for use of anti-emetics. Domperidone pharmacotherapy was cheaper and most frequently prescribed than ondansetron.

Pre-operative ondansetron vs. metoclopramide for prevention of post-operative nausea and vomiting in elective lower-segment caesarean section under spinal anaesthesia.

Background: The problem of nausea and vomiting is a very old but a less thought of problem. Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of post-operative nausea and vomiting (PONV). Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS) under spinal anaesthesia. Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were divided randomly into 2 groups of 50 each. Group I received IV metoclopramide 10mg and Group II received IV. Ondansetron 4mg. Anaesthetic management was standardized. The incidence of vomiting and retching as number of episodes was studied. Nausea was graded depending on the severity and data derived. Results: The mean age, weight and duration of surgery was not significantly different when compared group-1 parturiants with group-2. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreased (p<0.05) in Ondansetron group when compared to metoclopramide group as postoperative time progresses. Conclusions: Injection ondansetron 4mg provided decrease in the incidence of PONV than metoclopramide as the side effects with these drugs were minimal.

In vivo antipyretic, antiemetic, in vitro membrane stabilization, antimicrobial, and cytotoxic activities of different extracts from Spilanthes paniculata leaves

BACKGROUND: The study was conducted to evaluate the in vitro antimicrobial activity, cytotoxic, and membrane stabilization activities, and in vivo antiemetic and antipyretic potentials of ethanolic extract, n-hexane and ethyl acetate soluble fractions of Spilanthes paniculata leaves for the first time widely used in the traditional treatments in Bangladesh. RESULTS: In antipyretic activity assay, a significant reduction (P < 0.05) was observed in the temperature in the mice tested. At dose 400 mg/kg-body weight, the n-hexane soluble fraction showed the effect (36.7 ± 0.63°C ) as like as the standard (dose 150 mg/kg-body weight) after 5 h of administration. Extracts showed significant (P < 0.001) potential when tested for the antiemetic activity compared to the standard, metoclopramide. At dose 50 mg/kg-body weight, the standard showed 67.23% inhibition, whereas n-hexane and ethyl acetate soluble fractions showed 37.53% and 24.93% inhibition of emesis respectively at dose 400 mg/kg-body weight. In antimicrobial activity assay, the n-hexane soluble fraction (400 µg/disc) showed salient activity against the tested organisms. It exerts highest activity against Salmonella typhi (16.9 mm zone of inhibition); besides, crude, and ethyl acetate extracts showed resistance to Bacillus cereus and Bacillus subtilis, and Vibrio cholera respectively. All the extracts were tested for lysis of the erythrocytes. At the concentration of 1mg/ml, ethanol extract, and n-hexane and ethyl acetate soluble fractions significantly inhibited hypotonic solution induced lysis of the human red blood cell (HRBC) (27.406 ± 3.57, 46.034 ± 3.251, and 30.72 ± 5.679% respectively); where standard drug acetylsalicylic acid (concentration 0.1 mg/ml) showed 77.276 ± 0.321% inhibition. In case of heat induced HRBC hemolysis, the plant extracts also showed significant activity (34.21 ± 4.72, 21.81 ± 3.08, and 27.62 ± 8.79% inhibition respectively). In the brine shrimp lethality bioassay, the n-hexane fraction showed potent (LC50 value 48.978 µg/ml) activity, whereas ethyl acetate fraction showed mild (LC50 value 216.77 µg/ml) cytotoxic activity. CONCLUSIONS: Our results showed that the n-hexane extract has better effects than the other in all trials. In the context, it can be said that the leaves of S. paniculata possess remarkable pharmacological effects, and justify its folkloric use as antimicrobial, antipyretic, anti-inflammatory, and antiemetic agent. Therefore, further research may be suggested to find possible mode of action of the plant part.

Ginger and Its Pungent Constituents Non-Competitively Inhibit Serotonin Currents on Visceral Afferent Neurons

Nausea and emesis are a major side effect and obstacle for chemotherapy in cancer patients. Employ of antiemetic drugs help to suppress chemotherapy-induced emesis in some patients but not all patients. Ginger, an herbal medicine, has been traditionally used to treat various kinds of diseases including gastrointestinal symptoms. Ginger is effective in alleviating nausea and emesis, particularly, for cytotoxic chemotherapy drug-induced emesis. Ginger-mediated antiemetic effect has been attributed to its pungent constituents-mediated inhibition of serotonin (5-HT) receptor activity but its cellular mechanism of action is still unclear. Emetogenic chemotherapy drugs increase 5-HT concentration and activate visceral vagal afferent nerve activity. Thus, 5-HT mediated vagal afferent activation is essential to provoke emesis during chemotherapy. In this experiment, water extract of ginger and its three major pungent constituent's effect on 5-HT-evoked responses were tested on acutely dispersed visceral afferent neurons with patch-clamp methods. The ginger extract has similar effects to antiemetic drug ondansetron by blocking 5-HT-evoked responses. Pungent constituents of the ginger, [6]-shogaol, [6]-gingerol, and zingerone inhibited 5-HT responses in a dose dependent manner. The order of inhibitory potency for these compounds were [6]-shogaol>[6]-gingerol>zingerone. Unlike well-known competitive 5-HT3 receptor antagonist ondansetron, all tested ginger constituents acted as non-competitive antagonist. Our results imply that ginger and its pungent constituents exert antiemetic effects by blocking 5-HT-induced emetic signal transmission in vagal afferent neurons.

Observation of the efficacy of antiemetic herbal plaster preventing chemotherapy-induced vomiting after acu-point transdermal application / 中国基层医药

Objective To investigate the clinical efficacy of acupoint transdermal administered aniemetic herbal plaster combined with intraveous ondansetron preventing chemotheray -induced vomiting .Methods 98 cases of malignant tumor chemotherapy patients were randomly divided into the treatment group of 49 patients and a control group of 49 patients.The treatment group were acupoint transdermal administered animetic herbal plaster combined with intravenous ondansetron while the control group were intravenously administered ondansetron .The clinical effica-cy of preventing chemotheray-induced vomiting was observed .Results The total effective control rate of the treatment group was 93.9% compared with 79.6% of the control group,the efficacy of the treatment group was significantly greater than that in the control group ( P<0.05 ) .Conclusion The antiemetic herbal plaster exhibited significant effect on preventing chemotherapy-induced vomiting after acupoint transdermal application combined with intravenous ondansetron .