¿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.

¿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.

La administración de ondansetrón no mejora la evolución de los niños con gastroenteritis aguda sin deshidratación / Administration of ondansetron does not improve the course of children with acute gastroenteritis without dehydration

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)

Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)

O manejo da êmese em uma unidade oncológica: a necessidade da intervenção farmacêutica em tempo real / The Management of Emesis in an Oncology Unit: the Need for Pharmaceutical Intervention in Real Time

Introdução: Náuseas e vômitos estão entre os efeitos mais frequentes da quimioterapia antineoplásica, afetando cerca de 70% a 80% dos pacientes. A terapia antiemética objetiva prevenir o surgimento desses efeitos. Objetivo: Verificar a conformidade das prescrições de antieméticos, em uma unidade oncológica, de acordo com as diretrizes internacionais. Método: Estudo retrospectivo-descritivo a partir da coleta de dados das prescrições de quimioterapia do serviço de oncologia de um hospital universitário de Belém. Foram analisadas as prescrições dos pacientes ambulatoriais atendidos durante o período de um ano. Para a classificação do nível emetogênico de quimioterápicos isolados, utilizaram-se as classificações adotadas pela Multinational Association of Suportive Care in Cancer, American Society of Clinical Oncology e National Comprehensive Cancer Network; e, para associações de quimioterápicos, o algoritmo de Hesketh e colaboradores. Resultados: Entre as 143 prescrições analisadas, 27,3% apresentaram nível emetogênico baixo, 0,7% moderado e 72% alto. O estudo demonstrou que houve variabilidade entre as prescrições de antieméticos analisadas e as principais diretrizes. Quanto às não conformidades observadas, 53,8% ocorreram no manejo da terapia de nível emetogênico baixo, envolvendo associação ou dose; 100% no nível moderado e 27,2% no nível alto, relacionados à dose.Conclusão: A prevenção adequada das náuseas e vômitos é essencial para preservar a qualidade de vida dos pacientes oncológicos. Dessa forma, é necessário um protocolo intra-hospitalar para prescrição de antieméticos conforme as diretrizes internacionais. Esta pesquisa também alerta para a necessidade da intervenção farmacêutica em tempo real a fim de contribuir para o uso racional de medicamentos.

Comparison of intrathecal fentanyl and midazolam for prevention of nausea-vomiting during cesarean section under spinal anesthesia

Nausea and vomiting remain as [the big little problem] in cesarean section underspinal anesthesia. Incidence of nausea-vomiting during and immediately after surgery in spinal anesthesia is high. It is physically as well as mentally distressing to the patient and disturbing to the surgeon and the anesthesiologist. Purpose of this study was to compare the clinical efficacy of intrathecal fentanyl and midazolam for prevention of nausea-vomiting in parturients undergoing cesarean section under spinal anesthesia. This prospective randomized double blind study was conducted in 90 women aged between 18-31 years [ASA physical status I] scheduled to undergo elective cesarean section under spinal anesthesia. Subjects were randomly divided into three equal groups. Group A received 0.5 ml normal saline, Group B received 2 mg midazolam and Group C received 12.5 micro/g fentanyl with 2 ml of hyperbaric bupivacaine 0.5% intrathecally. Nausea-vomiting was assessed according to Belville's score. The statistical analysis of data was done by using statistical package for social science [SPSS] evaluation version 20. Results were expressed as mean, standard deviation, and range values. Frequencies expressed as number and percentage. ANOVA was used for multiple group comparisons, and categorical data were analyzed by Chi-square test. 24 subjects out of 30 in the placebo group developed intraoperative and early postoperative nausea-vomiting compared to 11 in midazolam group and 8 in fentanyl group. Incidence of intraoperative and early postoperative nausea-vomiting was 79.5% with placebo, 36.6% with midazolam and 26.6% with fentanyl. Intrathecal fentanyl 12.5 microg or midazolam 2 mg, both reduce the incidence and severity of nausea-vomiting when administered with bupivacaine for cesarean section

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

Carbamazepine for prevention of chemotherapy-induced nausea and vomiting: a pilot study / Carbamazepina para prevenção de náusea e vômito induzidos por quimioterapia: um estudo piloto

CONTEXT AND OBJECTIVE: Nausea and vomiting are major inconveniences for patients undergoing chemotherapy. Despite standard preventive treatment, chemotherapy-induced nausea and vomiting (CINV) still occurs in approximately 50% of these patients. In an attempt to optimize this treatment, we evaluated the possible effects of carbamazepine for prevention of CINV. DESIGN AND LOCATION: Prospective nonrandomized open-label phase II study carried out at a Brazilian public oncology service. METHODS: Patients allocated for their first cycle of highly emetogenic chemotherapy were continuously recruited. In addition to standard antiemetic protocol that was made available, they received carbamazepine orally, with staggered doses, from the third day before until the fifth day after chemotherapy. Considering the sparseness of evidence about the efficacy of anticonvulsants for CINV prevention, we used Simon's two-stage design, in which 43 patients should be included unless overall complete prevention was not achieved in 9 out of the first 15 entries. The Functional Living Index-Emesis questionnaire was used to measure the impact on quality of life. RESULTS: None of the ten patients (0%) presented overall complete prevention. In three cases, carbamazepine therapy was withdrawn because of somnolence and vomiting before chemotherapy. Seven were able to take the medication for the entire period and none were responsive, so the study was closed. There was no impact on the patients' quality of life. CONCLUSION: Carbamazepine was not effective for prevention of CINV and also had a deleterious side-effect profile in this population. .

CONTEXTO E OBJETIVO: Náusea e vômito são inconvenientes importantes para pacientes submetidos a quimioterapia. A despeito do tratamento preventivo padrão, náuseas e vômitos induzidos por quimioterapia (NVIQ) ocorrem em aproximadamente 50% dos pacientes. Na tentativa de otimizar este tratamento, avaliamos os possíveis efeitos da carbamazepina na prevenção de náuseas e vômitos induzidos por quimioterapia. TIPO DE ESTUDO E LOCAL: Estudo fase II, prospectivo, não randomizado, aberto, realizado em um serviço público brasileiro de oncologia. MÉTODOS: Recrutaram-se continuamente pacientes alocados para o primeiro ciclo de quimioterapia altamente emetogênica. Além do protocolo anti-emético padrão disponibilizado, os pacientes receberam carbamazepina, por via oral, em doses escalonadas, a partir do terceiro dia anterior até o quinto dia após a quimioterapia. Dada a escassa evidência de eficácia dos anticonvulsivantes na prevenção de NVIQ, adotamos o desenho de Simon em duas fases, que deveria incluir 43 pacientes a não ser que prevenção completa global não fosse alcançada em 9 dos primeiros 15 participantes. O questionário "Functional Living Index-Emesis" foi usado para avaliar o impacto na qualidade da vida. RESULTADOS: Nenhum dos 10 pacientes (0%) apresentou prevenção completa global. Três tiveram a carbamazepina suspensa por sonolência e vômito antes da quimioterapia. Sete foram capazes de tomar a medicação por todo o período proposto e nenhum obteve resposta, sendo então interrompido o estudo. Não houve impacto na qualidade da vida. CONCLUSÃO: Carbamazepina não foi efetiva para prevenção de NVIQ e apresentou perfil deletério de efeitos adversos nesta população. .

A Phase 3, randomized, double-blind study of single-dose fosaprepitant for prevention of cisplatin-induced nausea and vomiting: Results of an Indian population subanalysis.

Context: Currently, there is limited data on the prevention of chemotherapy-induced nausea and vomiting (CINV) in Indian patients. Aims: This post hoc study assessed the efficacy and safety of fosaprepitant compared with aprepitant for prevention of CINV in the Indian population. A subgroup analysis was performed from data collected in a phase 3 study of intravenous (IV) fosaprepitant or oral aprepitant, plus the 5-HT 3 antagonist ondansetron and the corticosteroid dexamethasone, in cisplatin-naοve patients with solid malignancies. Materials and Methods: Patients scheduled to receive cisplatin (≥70 mg/m 2 ) were administered a single IV dose of fosaprepitant dimeglumine (150 mg) on day 1 or a 3-day dosing regimen of oral aprepitant (day 1:125 mg, days 2 and 3:80 mg) with standard doses of ondansetron and dexamethasone. Patients recorded nausea and/or vomiting episodes and their use of rescue medication and were monitored for adverse events (AEs) and tolerability. Statistical Analysis Used: Differences in response rates between fosaprepitant and aprepitant were calculated using the Miettinen and Nurminen method. Results: In the Indian subpopulation (n = 372), efficacy was similar for patients in both the fosaprepitant or aprepitant groups; complete response in the overall, acute, and delayed phases and no vomiting in all phases were approximately 4 percentage points higher in the fosaprepitant group compared with the aprepitant group. Fosaprepitant was generally well-tolerated; common AEs were similar to oral aprepitant. Conclusions: IV fosaprepitant is as safe and effective as oral aprepitant in the Indian subpopulation and offers an alternative to the oral formulation.

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

PURPOSE: We investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted laparoscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane. MATERIALS AND METHODS: Sixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anesthesia was maintained with desflurane and remifentanil. In both groups, postoperative pain was controlled using fentanyl-based intravenous patient controlled analgesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue antiemetics and analgesics were recorded. RESULTS: The incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups. CONCLUSION: In order to prevent PONV after RLRP in the early postoperative period, anesthesia using TIVA with propofol is required regardless of patient-related risk factors.

[Study on the effect of preoperative dexamethasone to reduce vomiting in children undergoing tonsillectomy]

Tonsillectomy is the most frequent major procedure performed in children in the world. Patients may experience postoperative pain, vomiting, halitosis, trismus, weight lose and bleeding during their post surgical recovery, so preoperative steroid administration might be useful in decreasing postoperative symptoms in patients. This study performed on 50 patients. In case group after induction with halotan and nitrous oxide children received 1mg/kg to a maximum 25mg dexamethason prior to surgical procedure and in control group administered a single dose of distilled water. Episodes of PONV were recorded for the first 24h after operation. Results analysed with the software of SPSS Version 12. The prevalence of vomiting in case group at the recovery was 0% but in control group was 21.7% one time and 4.3% two times. There wasn't a significant relationship in PO time between both groups [P<0.005]. Vomiting in outpatient of case group were 85.2% no time, 11.1% one times, 3.7% three times and in control group 43.5% no time, 39.1% one time, 8.7% three times, 8.7% three times. The incidence and severity of PONV in the first 24 h were significantly less in the dexamethason group than in placebo group

Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes

Spinal anaesthesia for caesarean section exposes to high incidence of arterial hypotension which can result in maternal and neonatal morbidity. We hypothesized that the reduction of this dose from 10 mg to 7.5 mg would minimize hypotension without altering pain relief. In this double-blind prospective study, 80 ASA1 women scheduled for elective caesarean section were randomized into two groups A and B receiving respectively 10 and 7.5 mg of isobaric bupivacaine both with 25 micro g of fentanyl and 100 micro g of morphine in spinal anaesthesia. Intravenous ephedrine was administered for each episode of hypotension. We recorded sensory and motor block, intraoperative pain, nausea and vomiting. In postanaesthesia care unit, sensory and motor recoveries were measured and maternal satisfaction rate was assessed. In group A, a larger dose of ephedrine was needed [32 +/- 23 vs 19 +/- 16 mg; p=0.004]. Incidence of sensory block above T4 [52 vs 10%; p<0.001], nausea [52 vs 22%; p=0.005] and vomiting [25 vs 8%; p=0.03] were all higher than in group B. Arterial hypotension was less frequent in group B [68 vs 88%; p=0.03]. The time required for recovery to T10 sensory level and motor regression were shorter than in group A [p<0.001] and the satisfaction rate was higher than in group A [excellent and good in 90% vs 67%; p=0.03]. There was no difference in pain relief. A dose of 7.5 mg of isobaric bupivacaine reduced incidence of hypotension, nausea and vomiting and improved patient satisfaction

Cyclic vomiting syndrome responding to amitryptiline.

A 7 year girl presented with history of recurrent vomiting and altered sensonium. Laboratory investigators were within normal limits. A diagnosis of cyclic vomiting syndrome was made and treated with amitryptiline with good results.

Prophylactic antiemetic effects of midazolam, dexamethasone, and its combination after middle ear surgery

To evaluate and compare the efficacy of the combination of midazolam and dexamethasone, with midazolam and dexamethasone alone, for the prevention of postoperative nausea and vomiting [PONV] in female patients undergoing middle ear surgery. A prospective, randomized, double-blind, placebo-controlled study in 80 female patients [mean age 32.6 years], undergoing middle ear surgery with general anesthesia at Ohud Hospital, Madina, Kingdom of Saudi Arabia from May 2007 to May 2008. Patients were classified into 4 groups. They received intravenous normal saline [S group], midazolam 0.075 mg/kg [M group], or dexamethasone 10 mg [D group], or a combination of midazolam and dexamethasone [MD group], before the induction of anesthesia. Postoperatively for 24 hours observation and assessment of nausea, vomiting, rescue anti-emetics, and side effects of the study drugs such as headache and drowsiness were carried out. There was a significant difference between the 4 groups. The MD group was the least to develop PONV compared to other groups [p<0.01]. Regarding nausea, there was a non-significant difference between the 4 groups, although the MD group developed the least symptoms among the 4 groups, there were no significant differences in pain intensity and side effects such as, headache, dizziness, and drowsiness between the 4 groups. The combination of midazolam 0.075 mg/kg and dexamethasone 10 mg intravenously is better than either drug alone in reducing the incidence of PONV in female patients after middle ear surgery

efficacy of transcutaneous electrical nerve stimulation in control of nausea and vomiting in patients undergoing chemotherapy

Despite advances in antiemetic treatment, complications are still problematic for a significant number of patients after chemotherapy. This study was performed to determine the efficacy of transcutaneous electrical nerve stimulation [TENS] in the control of nausea and vomiting in patients undergoing chemotherapy at Nemazee Hospital in Shiraz, southern Iran.32 subjects with cancer from Outpatients Depatment in Nemazee Hospital affiliated to Shiraz University of Medical Sciences, in Shiraz, southern Iran were enrolled. The patients were randomly divided into two equal groups of TENS and placebo. Patients in both groups were matched for age, severity of nausea and vomiting and type of malignancy. Cisplatin or cyclophosphamide was used for chemotherapy and granistron along with dexametasone were used as antiemetic agents. In the test group, the p6 acupuncture point [acupoint] was stimulated by TENS when the antiemetic agent was administered and continued during wakening every 2 hours for 72 hours after chemotherapy. The placebo group was similarly treated but with an off mode stimulator. In regard to the severity of nausea, no statistically significant difference was observed between the two groups in the first 24 hours of chemotherapy but the intensity of nausea in the TENS group was significantly lower than those of the placebo group during 48 and 72 hours of chemotherapy. The mean frequency of vomiting during first, second and third 24 hours was significantly lower in the control group. TENS can be used as an adjunct with antiemetics for controlling nausea and vomiting induced by chemotherapy

Contribution to the treatment of nausea and emesis induced by chemotherapy in children and adolescents with osteosarcoma

CONTEXTO E OBJETIVO: A êmese induzida por quimioterapia é fator limitante no tratamento de crianças com câncer. O uso de quimioterapia com drogas emetogênicas tem aumentado a freqüência desse efeito colateral. O objetivo é comparar a eficácia e a toxicidade do granisetron às da combinação de altas doses de metoclopramida e dimenidrato em crianças com osteossarcoma utilizando a mesma quimioterapia. TIPO DE ESTUDO E LOCAL: Aberto, prospectivo, randomizado, realizado no Instituto de Oncologia Pediátrica, Departamento de Pediatria, Universidade Federal de São Paulo, Brasil. MÉTODOS: Entre fevereiro e agosto de 1994, 26 crianças com idade de 7 a 18 anos (média de 14 anos), recebendo quimioterapia para osteossarcoma, entraram no estudo. A quimioterapia consistiu de ciclos repetidos de: A) ifosfamida 2.500 mg/m² + epirrubicina 75 mg/m²; B) ifosfamida 2.500 mg/m² + carboplatina 600 mg/m²; C) carboplatina 600 mg/m² + epirrubicina 75 mg/m². 80 tratamentos quimioterápicos foram avaliados para o controle de náuse e vômito. Os pacientes foram randomizados para receber dose única de granisetron (50 µ/kg) ou metoclopramida (2 mg/kg) mais dimenidrato (5 mg/kg) infundidos por oito horas. Êmese e náusea foram monitoradas por 24 horas por meio de escore de MANE (Morrow Assessment of Nausea and Emesis). Foram utilizados testes de Qui-quadrado, t e Mann Whitney, além da técnica de análise exploratória de dados. RESULTADOS: O granisetron induziu resposta completa em 62,5% dos pacientes submetidos aos tratamentos quimioterápicos comparado a apenas 10% obtidos com a combinação de metoclopramida associado ao dimenidrato (p < 0,0001). CONCLUSÕES: Concluímos que o granisetron é droga segura e eficiente em crianças com osteossarcoma superior à associação de metoclopramida e dimenidrato no controle de náuseas e vômitos induzidos por quimioterapia para osteossarcoma em crianças.

Prevenção e tratamento das náuseas e vômitos induzidos pela quimioterapia antineoplásica / Prevention and treatment of nausea and vomiting induced by antineoplastic chemotherapy

Náuseas e vômitos decorrentes de quimioterapia têm um impacto negativo importante em pacientes com câncer, mas isso acabou levando a um considerável avanço em pesquisa neste campo. A grande maioria dos estudos se concentra no tratamento da emese aguda, onde se fez grandes avanços; por outro lado, a fisiopatologia da emese tardia não é tão bem entendida, constituindo-se num desafio terapêutico. A literatura mostra que o tratamento para emese aguda induzida por regimes altamente emetogênicos é a associação de antagonistas do receptor 5-HT3, mais dexametasona. Na emese tardia, metoclopramida e dexametasona é o tratamento de escolha para pacientes com bom controle dos episódios de emese prévio. Para aqueles com mau controle, sugere-se antagonistas do receptor 5-HT3, associados a dexametasona. Na prevenção da emese aguda induzida por quimioterápicos moderadamente emetogênicos, o regime mais efetivo é a combinação dos antagonistas dos receptores 5-HT3 e dexametasona. Na emese tardia, há a necessidade de mais estudos, pois até agora, não existem estudos comparando claramente os diversos tratamentos entre si.

Prevención de la náusea y vómito postoperatorio en rinoseptoplastía / Postoperative nausea and vomiting prevention in nose surgery

Se estudiaron 120 pacientes, todos sanos, de ambos sexos, sometidos a cirugía de Rinoseptoplastias, divididos en dos grupos. Al grupo A se le administraron 10 mg de Metoclopramida IV. Al grupo B se le administraron 10 mg de Metoclopramida, más 300 mg de Cimetidina IV. Ambos fármacos durante la inducción, valorando únicamente los efectos más indeseables después de una anestesia, como son las náuseas y los vómitos postoperatorios (NVPO). Todos los pacientes se manejaron en forma idéntica, tanto en la medicación preanestésica, inducción, mantenimiento, manejo quirúrgico y postoperatorio. El control de los mismos se llevó a cabo durante 24 horas que permanecieron hospitalizados. No se apreciaron efectos adversos durante el uso de estos medicamentos. Por los resultados obtenidos, se sugiere la combinación de la Metoclopramida y Cimetidina

Preliminary experience with use of a selective 5HT3 receptor antagonist (ondansetron) to prevent high dose chemotherapy induced emesis.

Ondansetron was used as an antiemetic along with dexamethasone during 16 cycles of highly or moderately ematogenic chemotherapy. There was major control in two cycles and complete control in the remaining 14. Side effects were minor and did not require discontinuation of the drug. This combination, therefore, appears to be safe and effective in preventing chemotherapy induced emesis.