Network Meta-analysis of oral Chinese patent medicine in adjuvant treatment of rotavirus gastroenteritis in children / 中国中药杂志

This study aimed to evaluate the efficacy and safety of various oral Chinese patent medicines in the adjuvant treatment of rotavirus gastroenteritis(RVGE) in children based on network Meta-analysis. Randomized controlled trial(RCT) of oral Chinese patent medicine in the adjuvant treatment of RVGE in children was retrieved from the databases such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science from database inception to October 22, 2022. The quality of the included RCT was evaluated according to the Cochrane risk-of-bias tool, and the data were analyzed by RevMan 5.4 and Stata 16 software. Sixty-three RCTs were included, with 11 oral Chinese patent medicines involved, including Xingpi Yanger Granules, Weichang'an Pills, Qiuxieling Mixture, Erxieting Granules, and Changyanning Granules/Syrup. The results of the network Meta-analysis showed that in terms of clinical total effective rate, the top 3 optimal interventions were Changyanning Granules/Syrup, Xiaoer Guangpo Zhixie Oral Liquid, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the anti-diarrheal time, the top 3 optimal interventions were Shenling Baizhu Granules, Qiuxieling Mixture, and Shuangling Zhixie Oral Liquid combined with conventional western medicine. In terms of the antiemetic time, the top 3 optimal interventions were Changyanning Granules/Syrup, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the antipyretic time, the top 3 optimal interventions were Shenling Baizhu Granules, Xiaoer Shuangjie Zhixie Granules, and Qiuxieling Mixture combined with conventional western medicine. In terms of the negative conversion rate of rotavirus, the top 3 optimal interventions were Xingpi Yanger Granules, Erxieting Granules, and Cangling Zhixie Oral Liquid combined with conventional western medicine. In terms of reducing creatine kinase isoenzyme MB(CK-MB) level, the top 3 optimal interventions were Weichang'an Pills, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of adverse reactions, no se-rious adverse reactions were reported in all studies. Oral Chinese patent medicines in the adjuvant treatment of children with RVGE have their own advantages, Specifically, Changyanning Granules/Syrup + conventional western medicine focuses on improving the clinical total effective rate and shortening the antiemetic time, Shenling Baizhu Granules + conventional western medicine on shortening the anti-diarrheal time and antipyretic time, Xingpi Yanger Granules + conventional western medicine on improving the negative conversion rate of rotavirus, and Weichang'an Pills + conventional western medicine on reducing the CK-MB level. Limited by the quantity and quality of literature included in this study, the results need to be verified by high-quality RCT with a larger sample size.

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465

Application of Methylprednisolone Sodium Succinate Combined with Tropisetron in Prevention of Nausea and Vomiting under Microvascular Decompression of Hemifacial Spasm / 中国医学科学院学报

Objective To evaluate the effect of methylprednisolone sodium succinate combined with tropisetron on postoperative nausea and vomiting(PONV)under microvascular decompression of hemifacial spasm.Methods From January to June 2019,485 patients undergoing microvascular decompression for facial spasm at Department of Neurosurgery,Peking University People's Hospital were randomly assigned into two groups with random number table method.For group A(n=242),2 ml saline was administrated by intravenous drip before induction and 5 mg tropisetron after operation.For group B(n=243),40 mg methylprednisolone sodium succinate was administrated by intravenous drip before induction and 5 mg tropisetron after operation.The anesthesia time,operation time,and incidence of PONV in 0-24 h and 24-48 h were recorded for the comparison of the remedial treatment rate of nausea and vomiting between the two groups.Results There was no significant difference in age,gender,smoking history,body mass index value,American Society of Anesthesiologists score,medical history,surgical side,PONV history,operation time or anesthesia time between the two groups(all P > 0.05).The incidence of PONV in group A was 35.5% and 18.2% during 0-24 h and 24-48 h,respectively,which was significantly higher than that(18.5%,χ

Comparison of palonosetron-dexamethasone and ondansetron-dexamethasone for prevention of postoperative nausea and vomiting in middle ear surgery: a randomized clinical trial / Comparação entre palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náuseas e vômitos no pós-operatório de cirurgia do ouvido médio: estudo clínico randomizado

Abstract Background: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery. Methods: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded. Results: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026). Conclusion: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.

Resumo Justificativa: Náusea e vômito no pós-operatório é a segunda queixa pós-operatória mais frequente após a dor. Sem profilaxia antiemética, a incidência de náusea e vômito no pós-operatório foi de 60−80% após cirurgia do ouvido médio. Dada a alta incidência relatada de náusea e vômito no pós-operatório, nosso objetivo foi avaliar o efeito da combinação de palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náusea e vômito no pós-operatório em pacientes submetidos a cirurgia do ouvido médio. Método: Sessenta e quatro pacientes programados para cirurgia de ouvido médio foram aleatoriamente divididos em dois grupos. Um recebeu a combinação de palonosetrona-dexametasona (grupo P) e o outro ondansetrona-dexametasona (grupo O) por via intravenosa antes da indução anestésica. A técnica anestésica foi padronizada em todos os pacientes. No pós-operatório, foram registradas incidência e gravidade das náuseas e vômitos, necessidade de antiemético de resgate, efeitos colaterais e índice de satisfação dos pacientes. Resultados: As características demográficas foram semelhantes nos grupos estudados. A diferença na incidência de náusea foi estatisticamente significante entre os grupos O e P apenas no intervalo de tempo entre 2 e 6 horas (p = 0,026). A incidência e gravidade de vômito não foram estatisticamente significantes entre os grupos O e P durante todo o período do estudo. A incidência geral de náusea e vômito no pós-operatório (0−24 horas de pós-operatório) foi de 37,5% no grupo O e de 9,4% no grupo P (p = 0,016). A combinação palonosetrona-dexametasona associou-se com redução do risco absoluto de 28%, redução do risco relativo de 75%, e o número necessário para tratar foi 4. O escore de satisfação do paciente foi maior no grupo P (p = 0,016). A frequência da medicação de resgate foi mais comum no grupo O (p = 0,026). Conclusão: A combinação de palonosetrona-dexametasona é superior à ondansetrona-dexametasona na prevenção da náusea e vômito no pós-operatório após cirurgia de ouvido médio.

Effect of palonosetron, ondansetron and dexamethasone in the prevention of postoperative nausea and vomiting in video cholecystectomy with total venous anesthesia with propofol-remifentanil - randomized clinical trial / Efeito da palonosetrona, ondansetrona e dexametasona na prevenção de náusea e vômito pós-operatório em videocolecistectomia com anestesia venosa total com propofol-remifentanil - ensaio clínico randomizado duplo cego

Abstract Introduction and objectives: The incidence of Postoperative Nausea and Vomiting (PONV) after video cholecystectomy is high. Progress in pharmacological PONV prophylaxis includes a new generation of 5-HT3 antagonists. This study aims to assess the effect of the 5-HT3 antagonist in postanesthetic antiemetic management of patients submitted to laparoscopic cholecystectomy with total intravenous anesthesia. Methods: Sixty individuals who underwent video cholecystectomy were randomized into three groups of 20 individuals according to the treatment administered: 0.125 mg of palonosetron (Group 1); 4 mg of ondansetron associated with 4 mg of dexamethasone (Group 2); 4 mg of dexamethasone (Group 3). General intravenous anesthesia was performed with propofol, remifentanil and rocuronium. The group to which the participant belonged was concealed from the investigator who assessed drug effect. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. Rescue medication was 0.655 to 1.5 mg of droperidol. Results: Group 1 presented a lower incidence of PONV and required less rescue medication in the first postoperative hour. There was no significant difference among the three groups regarding PONV incidence in the first 12 postoperative hours. Groups 1 and 2 were superior to Group 3 regarding the control of PONV from 12 to 24 hours, and after rescue medication from 12 to 24 hours. Group 1 showed significantly superior nausea control in the first 12 postoperative hours. Conclusions: The present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea.

Resumo Justificativa e objetivo: Náuseas e Vômitos no Pós-Operatório (NVPO) têm alta incidência após videocolecistectomia. Avanços na profilaxia farmacológica de NVPO incluem a nova geração de antagonista 5-HT3. O objetivo deste estudo foi avaliar o efeito do antagonista 5-HT3 no controle antiemético pós-anestésico em videocolecistectomia com anestesia venosa total. Método: Estudo realizado no HC-UFU (Hospital Terciário). Sessenta indivíduos submetidos a videocolecistectomia foram randomizados em três grupos de igual número, sendo administrados 0,125 mg de palonosetrona (Grupo 1); 4 mg de ondasetrona e 4 mg de dexametasona (Grupo 2); ou 4 mg de dexametasona (Grupo 3). A anestesia geral venosa foi realizada com propofol, remifentanil e rocurônio. O avaliador do efeito da droga desconhecia o grupo ao qual o indivíduo pertencia. NVPO foi avaliada aplicando a Escala de Rhodes após 12 e 24 horas do término da cirurgia. Para resgate terapêutico, foi estabelecido 0,655−1,5 mg de droperidol. Resultado: Observou-se no Grupo 1 menor incidência de NVPO e de resgate terapêutico na primeira hora de PO. Não foi observada diferença significativa entre os três grupos com relação a ocorrência de NVPO nas primeiras 12 horas de pós-operatório. Os grupos 1 e 2 foram superiores ao Grupo 3 no que se refere ao controle de NVPO de 12 a 24 horas e após o resgate de 12−24 horas. Observou-se que o controle de náuseas nas primeiras 12 horas de pós-operatório do Grupo 1 foi significantemente superior. Conclusão: O presente estudo mostrou evidências da superioridade da palonosetrona às demais drogas empregadas no que se refere ao efeito antiemético prolongado e menor necessidade de resgate, principalmente na capacidade de inibir completamente o desconfortável sintoma de náusea.

Effect of acupuncture on the prevention of nausea and vomiting after laparoscopic cholecystectomy: a randomized clinical trial / Efeitos da acupuntura para a prevenção de náuseas e vômitos após colecistectomia laparoscópica: estudo clínico randomizado

Abstract Background and objectives: Postoperative nausea and vomiting (PONV) is a common and undesirable complication observed after laparoscopic cholecystectomy (LC). We investigated the effects of auriculoacupuncture (AA) on the prevention of postoperative nausea and vomiting in the immediate postoperative period of uncomplicated laparoscopic cholecystectomy. Methods: Sixty-eight patients were randomly divided into two groups, auriculoacupuncture (n = 35) and control (n = 33), and then they were evaluated prospectively. The needle was placed before anaesthesia induction and remained for 20 minutes. Nausea intensity was evaluated using an analogic visual scale and PONV events were registered immediately after anaesthesia care unit admission and in the second, fourth and sixth hours after the surgery. Results: The auriculoacupuncture group had a significantly smaller incidence of nausea and vomiting than the control group throughout the whole postoperative period (16/35 vs. 27/33, p= 0.03 and 4/35 vs. 15/33, p= 0.005, respectively); the AA group had fewer nausea events 2 h (p= 0.03) and 6 h (p= 0.001) after surgery and fewer vomiting events 2 h (p= 0.01) and 6 h (p= 0.02) after surgery. Conclusions: Auriculoacupuncture can partially prevent postoperative nausea and vomiting when compared to metoclopramide alone after uncomplicated laparoscopic cholecystectomy. Auriculoacupuncture can be recommended as an adjuvant therapy for postoperative nausea and vomiting prevention in selected patients.

Resumo Justificativa e objetivos: Náuseas e vômitos são complicações comuns e indesejáveis no pós-operatório de colecistectomia laparoscópica (CL). Nós investigamos os efeitos da auriculoacupuntura (AA) para a prevenção de náuseas e vômitos no período pós-operatório (NVPO) imediato da CL não complicada. Métodos: 68 pacientes foram aleatoriamente divididos em dois grupos, auriculoacupuntura (n = 35) e controle (n = 33), e foram avaliados prospectivamente. A agulha foi aplicada antes da indução anestésica e permaneceu no lugar por 20 minutos. A intensidade da náusea foi avaliada mediante escala visual analógica e episódios de NVPO foram registrados imediatamente após a admissão na unidade de recuperação anestésica e duas, quatro e seis horas após a cirurgia. Resultados: O grupo AA apresentou significativamente menos episódios de NVPO do que o grupo controle durante todo o período pós-operatório (16/35 vs. 27/33, p = 0,03 e 4/35 vs. 15/33, p = 0,005, respectivamente). O grupo auriculoacupuntura apresentou episódios de náuseas menos intensos às 2 horas (p = 0,03) e 6 horas (p = 0,001) após a cirurgia e menos episódios de vômitos 2 horas (p = 0,01) e 6 horas (p = 0,02) após a cirurgia. Conclusão: A auriculoacupuntura aliviou náuseas e vômitos no pós-operatório em número significante de pacientes, mas não foi capaz de prevenir náuseas e vômitos no pós-operatório em todos os pacientes. Ela pode ser recomendada como terapia adjuvante para prevenção de náuseas e vômitos no pós-operatório no pós-operatório de colecistectomia laparoscópica em pacientes selecionados.

Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis / Antagonistas do receptor da neurocinina-1 no tratamento de náusea e vômito no pós-operatório: Revisão sistemática e meta-análise

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, and Neurokinin-1 (NK-1) receptor antagonists have been used to treat PONV. Objectives: To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant. Data sources: Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used. Study eligibility criteria, participants, and interventions: Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included. Study appraisal and synthesis methods: All statistical assessments were conducted by a random effect approach, and odds ratios and 95% Confidence Intervals were calculated. Results: Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001). Limitations: Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present. Conclusions and implications of key findings: Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses. Systematic review registration number: CRD42019120188.

Resumo Histórico: Náusea e Vômito no Pós-Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5-Hidroxitriptamina3 (5-HT3) e antagonistas do receptor da Neurocinina-1 (NK-1), têm sido utilizados para tratar a NVPO. Objetivo: Comparar o efeito antiemético dos antagonistas do receptor NK-1, incluindo o fosaprepitanto. Fontes de dados: Foram utilizadas bases de dados on-line (PubMed, MEDLINE, Scopus, The Cochrane Library). Critérios de elegibilidade do estudo, participantes e intervenções: Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK-1 e antagonistas do receptor 5-HT3, e que comparassem a incidência de NVPO. Métodos de avaliação e síntese do estudo: Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%. Resultados: As doses de 40 mg e 80 mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós-operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30-0,54; p < 0,001 e OR = 0,32; 95% IC 0,19-0,56; p < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0-24 horas como no período de 0-48 horas pós-operatórias (OR = 0,07; 95% IC 0,02-0,24; p < 0,001 e OR = 0,07; 95% IC 0,02-0,23; p < 0,001). Limitações: Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés. Conclusões e implicações dos principais achados: Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós-operatório. No entanto, são necessários mais estudos para elaboração de meta-análises de melhor qualidade. Número de registro da revisão sistemática: CRD42019120188.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Cumulative incidence and risks factors for postoperative nausea and vomiting in adult patients undergoing cholecystectomy under balanced general anesthesia: a prospective cohort study / Incidencia acumulada y factores de riesgo para náuseas y vómitos posoperatorios en pacientes adultos sometidos a colecistectomía bajo anestesia general balanceada: estudio prospectivo de cohorte

Abstract Introduction: Postoperative nausea and vomiting (PONV) are common issues arising after general anesthesia, for which several independent risk factors (RF) have been described. Objective: To determine the accumulated incidence of PONV during the first 24hours of the postoperative period. Methods: A cohort observational, prospective study was conducted that included all the adults undergoing cholecystectomy under balanced general anesthesia at the EsSalud Talara Hospital from October 2014 until December 2016. The presence of PONV during the first 24hours after surgery was assessed, and univariate, bivariate, and logistic regression analyses were conducted. Results: A total of 244 patients were included, most of them with 2 RFs in the Apfel scale, that represented an accumulated incidence of PONV of 0.51 (95% confidence interval [CI] 0.45-0.57) during the observation period, notwithstanding the fact that 85.25% received antiemetic prophylaxis. The logistic regression analysis identified that being a female (odds ratio [OR] 3.30,95% CI 1.66-6.55, P = 0.0007) and previous PONV or motion sickness (OR 2.67, 95% CI 1.25-5.68, P = 0.011) were independent RFs for PONV. The administration of antiemetic prophylaxis and the presence of PONV (P = 0.92) were found to be independent. Conclusion: The high cumulative incidence of PONV could be the result of the type of surgery, the use of volatile anesthetic agents, and errors in the antiemetic pharmacological prophylaxis.

Resumen Introducción: Las náuseas y vómitos posoperatorios (NVPO) son problemas comunes que aparecen luego de la anestesia general, para los que se han descrito varios factores independientes de riesgo. Objetivo: Determinar la incidencia acumulada de NVPO durante las primeras 24 horas del periodo posoperatorio. Métodos: Se realizó un estudio observacional prospectivo de cohorte que incluyó a todos los adultos sometidos a colecistectomía bajo anestesia general balanceada en el Hospital EsSalud Talara desde octubre de 2014 hasta diciembre de 2016. Se evaluó la presencia de NVPO durante las primeras 24 horas posoperatorias y se ejecutaron análisis univariado, bivariado y de regresión logística. Resultados: Se incluyeron 244 pacientes, la mayoría con dos factores de riesgo en la escala de Apfel, que presentaron una incidencia acumulada de NVPO de 0.51 (IC 95% 0.45-0.57) en el periodo de observación, a pesar de que el 85.25% recibió profilaxis antiemética. El análisis de regresión logística identificó la presencia de sexo femenino (OR 3.30, IC 95% 1.66-6.55, p = 0.0007) y la historia de NVPO previos o cinetosis (OR 2.67, IC 95% 1.25-5.68, p = 0.011) como factores de riesgo independientes para NVPO. Se halló independencia entre la presencia de profilaxis antiemética y la presencia de NVPO (p=0.92). Conclusiones: La alta incidencia acumulada de NVPO pudiera ser ocasionada por el tipo de cirugía, uso de anestésicos volátiles y falencias en la profilaxis farmacológica antiemética.

¿Puede el fentanilo intratecal disminuir la aparición de náuseas y vómito en comparación con ondansetrón intravenoso durante cesárea electiva? Revisión sistemática de la literatura y metaanálisis / Can intrathecal fentanyl decrease the occurrence of nausea and vomiting compared with intravenous ondansetron during elective cesarean section? Literature Systematic review and meta-analysis

Elective caesarean section is one of the surgeries with the highest intraoperative incidence of nausea, retching and vomiting (IONV), due, among other causes, to the use of anesthetics during the procedure. Some clinical trials have associated the use of low-dose intrathecal (IT) fentanyl with a lower incidence of nausea, retching and vomiting compared to other anesthetics used during caesarean sections. In this context, the objective of this meta-analysis was to evaluate the decrease in the appearance of nausea and vomiting during elective caesarean section with the application of IT fentanyl when compared with the use of intravenous ondansetron (EV). A systematic search was conducted in the main databases (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library and Google Scholar) for Randomized Clinical Trials (RCTs) that evaluated the use of IT fentanyl compared to ondansetron EV to decrease the occurrence and incidence of IONV during elective caesarean section. The meta-analysis showed a reduction in the incidence of nausea (RR 0.52, 95% CI 0.29-0.93, P = 0.03), gagging (RR 0.39, 95% CI 0, 18-0.88, P = 0.02) and vomiting (RR 0.26, 95% CI 0.11-0.64, P = 0.003) in the group of patients treated with IT fentanyl compared to the group treated with EV ondansetron. From the results, it is suggested that the administration of 12.5 to 20 µg of IT fentanyl may decrease the incidence of IONV in patients undergoing elective caesarean section, although the importance of more high-quality RCTs is highlighted.

La cesárea electiva es una de las cirugías con mayor incidencia intraoperatoria de náuseas, arcadas y vómito (NAV), debido entre otras causas, al uso de anestésicos durante el procedimiento. Algunos ensayos clínicos han asociado el uso de fentanilo intratecal (IT) a dosis bajas con una menor incidencia de náuseas, arcadas y vómito en comparación con otros anestésicos usados durante las cesáreas. En este contexto el objetivo de este metaanálisis fue evaluar la disminución en la aparición de náuseas y vómito durante cesárea electiva con la aplicación de fentanilo IT al compararlo con el uso de ondansetrón intravenoso (EV). Se realizó una búsqueda sistemática en las principales bases de datos (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library y Google Scholar) para ensayos clínicos aleatorizados (ECA) que evaluaron el uso del fentanilo IT en comparación con ondansetrón EV para disminuir la aparición e incidencia de IONV durante cesárea electiva. En el metaanálisis se evidenció una reducción en la incidencia de náusea (RR 0,52, 95% IC 0,29-0,93, P = 0,03), arcada (RR 0,39, 95% IC 0,18-0,88, P = 0,02) y vómito (RR 0,26, 95% IC 0,11-0,64, P = 0,003) en el grupo de pacientes tratados con fentanilo IT comparado con el grupo tratado con ondansetrón EV. A partir de los resultados, se sugiere que la administración de 12,5 a 20 µg de fentanilo IT puede disminuir la incidencia de NAV intraoperatorias en pacientes sometidas a cesárea electiva, aunque se resalta la importancia de más ECA de alta calidad.

Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting / Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

RESUMO OBJETIVO: Estimar a incidência e avaliar os fatores de risco para náuseas e vômitos induzidos por antineoplásicos com alto e moderado potencial emético em pacientes adultos, no primeiro ciclo de tratamento. MÉTODOS: Estudo de coorte prospectiva, com 269 adultos acompanhados durante o primeiro ciclo de quimioterapia antineoplásica. A incidência de náuseas e vômitos foi avaliada na fase aguda (0-24 horas), na fase tardia (24 horas-5° dia) e na fase total (0-5° dia). RESULTADOS: 152 pacientes foram submetidos a quimioterápico com alto potencial emético e 117 a moderado potencial emético. A frequência relativa de náuseas foi maior quando comparada à de vômitos na fase aguda (p < 0,001) e na fase tardia (p < 0,001). Os fatores de risco identificados foram: faixa etária ≤ 49 anos (odds ratio = 0,47; IC95% 0,23-0,95) e 50-64 anos (odds ratio = 0,45; IC95% 0,23-0,87), uso de tabaco (odds ratio = 0,35; IC95% 0,14-0,88) e alto potencial emético dos quimioterápicos (odds ratio 0,55; IC95% 0,31-0,95). CONCLUSÃO: A incidência de náuseas foi maior do que a de vômitos, e na fase tardia os efeitos adversos foram mais frequentes. Os resultados sugerem que os fatores de risco para náuseas e vômitos induzidos por quimioterapia são o tabaco, a idade (adultos jovens) e o alto potencial emético do quimioterápico.

Benefits of ginger in the control of chemotherapy-induced nausea and vomiting / Beneficios del jengibre en el control de náusea y vómito inducidos por la quimioterapia / Benefícios do gengibre no controle da náusea e vômito induzidos pela quimioterapia

ABSTRACT Objectives: To identify and discuss scientific evidence of the effects of ginger use on the management of chemotherapy-induced nausea and vomiting. Methods: This is an integrative reviewperformed by Ganong's reference. Results: We included 24 studies, highlighting three thematic categories, namely 1) antiemetic action of ginger - nausea (13 articles; of these, nine significant) and emesis (10 studies; of these, six significant); 2) action in the control of nausea (11 articles; of these, six significant) and vomiting (8 articles; of these, three significant) in the acute phase; 3) action in the control of nausea (6 articles; of these, three significant) and vomiting (6 articles; of these, three significant) in the delayed phase. There were divergences of the methods used. Final considerations: This complementary therapy has low cost and easy access, but no statistical confirmation of its effectiveness in the management of nausea and vomiting in cancer patients was found.

RESUMEN Objetivos: Identificar y discutir evidencias científicas de los efectos del uso del jengibre en el manejo de la náusea y vomito inducidos por la quimioterapia. Métodos: Se trata de revisión integranterealizada por el referencial Ganong. Resultados: Han sido incluidos 24 estudios, destacándose 3 categorías temáticas: 1) acción antiemética del jengibre - ha sido evaluada la náusea (13 artículos [9 significativos]) y emesis (10 estudios [6 significativos]); 2) acción en el control de la náusea (11 artículos [6 significativos]) y vomito (8 artículos [3 significativos]) en la fase aguda; 3) acción en el control de la náusea (6 artículos [3 significativos]) y vomito (6 artículos [3 significativos]) en la fase tardía. Hubo divergencias de los métodos utilizados. Consideraciones finales: Esa terapia complementar ha sido de bajo costo y fácil acceso, pero no ha sido encontrada confirmación estadística de su efectividad en el manejo de la náusea y vomito en pacientes oncológicos.

RESUMO Objetivos: Identificar e discutir evidências científicas dos efeitos do uso do gengibre no manejo da náusea e vômito induzidos pela quimioterapia. Métodos: Trata-se de revisão integrativabaseada no referencial de Ganong. Resultados: Foram incluídos 24 estudos, destacando-se 3 categorias temáticas, a saber, 1) ação antiemética do gengibre - foi avaliada a náusea (13 artigos; destes, 9 significativos) e êmese (10 estudos; destes, 6 significativos); 2) ação no controle da náusea (11 artigos; destes, 6 significativos) e vômito (8 artigos; destes, 3 significativos) na fase aguda; 3) ação no controle da náusea (6 artigos; destes, 3 significativos) e vômito (6 artigos; destes, 3 significativos) na fase tardia. Houve divergências dos métodos utilizados. Considerações finais: Essa terapia complementar é de baixo custo e fácil acesso, mas não foi encontrada confirmação estatística de sua efetividade no manejo da náusea e vômito em pacientes oncológicos.

Extrapiramidalismo por antieméticos / Extrapyramidal Side Effects of Antiemetics / Reações extrapiramidais causadas por antieméticos

Resumen: Los antieméticos son usados frecuentemente por diversas áreas de la medicina, aunque existe una tendencia a subestimar sus efectos adversos neurológicos. El objetivo del presente estudio de revisión fue revisar la literatura sobre la fisiología, farmacología, factores predisponentes, clínica y manejo del extrapiramidalismo por antieméticos. Se realizó una búsqueda en la literatura de artículos de revistas científicas, libros y trabajos de grado. Se utilizaron los buscadores Medline, LILACS, PubMed, EMBASE, Current contents y Google Scholar con las siguientes palabras claves: deshidratación, gastroenteritis, vómitos, antieméticos, distonía, dopamina, hipertermia, citocromo, meto-clopramida y domperidona. Se obtuvieron 252 artículos, de los cuales 50 fueron considerados aptos para la revisión. A partir del análisis, se concluyó que el uso de antieméticos es de uso frecuente por medicina general y especialidades como anestesiología y pediatría, por lo cual un conocimiento sobre los efectos extrapiramidales permitirá un diagnóstico y manejo temprano.

Abstract: Antiemetics are frequently used by various areas of medicine, although there is a tendency to underestimate their neurological adverse effects. This paper aims to review the literature on the physiology, pharmacology, predisposing factors, clinical picture, and management of the extrapyramidal side effects of antiemetics. Scientific journal articles, books, and dissertations were searched. The search engines Medline, LILACS, PubMed, EMBASE, Current Contents, and Google Scholar were used with the following keywords: dehydration, gastroenteritis, vomit, antiemetics, dystonia, dopamine, hyperthermia, cytochrome, metoclopramide, and domperidone. Two hundred and fifty-two articles were obtained, 50 of which were considered suitable for review. From the analysis, it was concluded that antiemetics are often used by general medicine and specialties such as anesthesiology and pediatrics; therefore, knowledge of the extrapyramidal effects will allow early diagnosis and treatment.

Resumo: Os antieméticos são frequentemente usados por diversas áreas da medicina, embora possamos constatar uma tendência a subestimar seus efeitos adversos neurológicos. O objetivo do presente estudo é revisar a literatura sobre a fisiologia, a farmacologia, os fatores predisponentes, a clínica e o tratamento de reações extrapiramidais causadas por antieméticos. Foi realizada uma busca na literatura por artigos de revistas científicas, livros e monografias. Os mecanismos de busca Medline, LILACS, PubMed, EMBASE, Current contents e Google Scholar foram utilizados com as seguintes palavras-chave: desidratação, gastroenterite, vómito, antieméticos, distonia, dopamina, hipertermia, citocromo, metoclopramida e domperidona. Foram encontrados 252 artigos, dos quais 50 foram considerados aptos para a revisão. A partir da análise, concluiu-se que os antieméticos são frequentemente utilizados pela medicina geral e especialidades, como anestesiologia e pediatria, portanto, o conhecimento dos efeitos extrapiramidais possibilitará um diagnóstico e tratamento precoces.

Perspectiva histórica do tratamento clínico da doença do refluxo gastroesofágico / Historical perspective of gastroesophageal reflux disease clinical treatment

ABSTRACT BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das doenças gastrointestinais mais prevalentes, resultando em limitações significativas na qualidade de vida dos pacientes e, também, relevante utilização de recursos médicos. Um melhor entendimento da fisiopatologia da doença nas últimas cinco décadas tem favorecido a evolução das estratégias de tratamento, desde intervenções não farmacológicas e antiácidos, a alternativas mais eficazes e seguras. OBJETIVO: Resumir os dados sobre a evolução histórica do manejo da DRGE no Brasil, focando na terapia medicamentosa e abordando evidências sobre a eficácia e segurança de classes medicamentosas atualmente recomendadas. MÉTODOS: Uma revisão narrativa foi conduzida para sistematizar informações sobre descobertas na fisiopatologia da DRGE e, também, sobre a eficácia e segurança de medicamentos utilizados atualmente para reduzir os sintomas e melhorar a cicatrização endoscópica de lesões esofágicas. Uma busca estruturada na base de dados Pubmed foi realizada para identificar revisões sistemáticas e metanálises que investigassem desfechos da doença impactados positivamente pelos inibidores da bomba de prótons (IBPs), a primeira escolha farmacológica para a doença. RESULTADOS: O desenvolvimento cronológico das medidas terapêuticas para a DRGE no Brasil evoluiu de modificações no estilo de vida que demonstraram relativamente pouco efeito sobre os sintomas relacionados à exposição esofágico ao ácido, particularmente a azia, a intervenções farmacológicas eficazes e seguras como os anti-histamínicos H2 e os IBPs. Atualmente, algumas classes de medicamentos exercem um papel menor no manejo da doença, procinéticos e antiácidos por exemplo, devido à sua eficácia reduzida e a preocupações relevantes quanto a segurança (particularmente com os procinéticos). O principal desafio para os prescritores e pesquisadores parece ser encontrar estratégias supressoras de ácidos de longa duração capazes de melhorar os sintomas e a qualidade de vida dos pacientes, reduzindo assim o consumo de recursos médicos. O dexlansoprazol, um IBP de liberação retardada dupla, parece responder a algumas limitações que outros IBPs têm. CONCLUSÃO: O reconhecimento da evolução histórica do manejo da DRGE pode auxiliar aos profissionais assistentes a melhor entender as opções terapêuticas para seus pacientes, assim como focar em necessidades não atendidas que necessitem de maior atenção. IBPs ainda são a terapia de escolha inicial, com boas evidências a favor de sua eficácia, apesar algumas questões acerca da segurança de seu uso. No entanto, assim como para qualquer intervenção medicamentosa, é recomendada a prescrição dos IBPs para pacientes com indicação clara, utilizando doses adequadas e monitorando a ocorrência de eventos adversos.

A Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Moderately Emetogenic Chemotherapy: Results of the Korean South West Oncolog / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Data on the efficacy of olanzapine in patients receiving moderately emetogenic chemotherapy (MEC) are limited. This study aimed to evaluate and compare the efficacy of olanzapine versus placebo in controlling nausea and vomiting in patients receiving MEC. MATERIALS AND METHODS: We conducted a randomized, double-blind, placebo-controlled study to determine whether olanzapine can reduce the frequency of chemotherapy-induced nausea and vomiting (CINV) and improve the quality of life (QOL) in patients receiving palonosetron and dexamethasone as prophylaxis for MEC-induced nausea and vomiting. The primary end point was complete response for the acute phase (0-24 hours after chemotherapy). The secondary end points were complete response for the delayed (24-120 hours) and overall phase (0-120 hours), proportion of significant nausea (visual analogue scale ≥ 25 mm), use ofrescue medications, and effect on QOL. RESULTS: Fifty-six patients were randomized to the olanzapine (n=29) and placebo (n=27) groups. Complete response rates were not significantly different between the olanzapine and placebo groups in the acute (96.5% vs. 88.0%, p=0.326), delayed (69.0% vs. 48.0%, p=0.118), and overall phases (69.0% vs. 48.0%, p=0.118). However, the percentage of patients with significant nausea (17.2% vs. 44.0%, p=0.032) and the use of rescue medications (0.03±0.19 vs. 1.88±2.88, p=0.002) were lower in the olanzapine group than in the placebo. Furthermore, the olanzapine group demonstrated better QOL (p=0.015). CONCLUSION: Olanzapine combined with palonosetron and dexamethasone significantly improved QOL and vomiting control among previously untreated patients receiving MEC, although the efficacy was limited to the reduction of the frequency of CINV.

The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial

BACKGROUND: The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group. METHODS: Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured. RESULTS: Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were 0.14 ± 0.37, 4.57 ± 2.37, 6.00 ± 1.63, and 4.28 ± 1.49, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB. CONCLUSIONS: In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB.

Management of Acute Gastroenteritis in Children: A Survey among Members of the Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition / 대한소아소화기영양학회지

PURPOSE: No national survey has yet described the guidelines followed by Korean pediatricians to treat acute gastroenteritis (AGE). An online survey was performed to investigate the management of AGE followed by members of The Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition, and the results were compared between pediatric gastroenterologists (PG) and general pediatricians (GP). METHODS: Questionnaires were sent to pediatricians between June 2 and 4, 2018 regarding the type of hospital, indications for admission, antiemetic and antidiarrheal drugs and antibiotics prescribed, and dietary changes advised. RESULTS: Among the 400 pediatricians approached, 141 pediatricians (35.3%) responded to the survey. PG comprised 39% of the respondents and 72.7% worked at a tertiary hospital. Both PG and GP considered diarrhea or vomiting to be the primary symptom. The most common indication for hospitalization was severe dehydration (98.8%). Most pediatricians managed dehydration with intravenous fluid infusions (PG 98.2%, GP 92.9%). Antiemetics were prescribed by 87.3% of PG and 96.6% of GP. Probiotics to manage diarrhea were prescribed by 89.1% of PG and 100.0% of GP. Antibiotics were used in children with blood in diarrheal stool or high fever. Dietary changes were more commonly recommended by GP (59.3%) than by PG (27.3%) (p<0.05). Tests to identify etiological agents were performed primarily in hospitalized children. CONCLUSION: This survey assessing the management of pediatric AGE showed that the indications for admission and rehydration were similar between GP and PG. Drug prescriptions for diarrhea and dietary changes were slightly commonly recommended by GP than by PG.