Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery.

STUDY OBJECTIVES: To determine the incidence of postoperative nausea and vomiting when a combination of ondansetron and promethazine is given prophylactically, and to ascertain the effect of postoperative nausea and vomiting on recovery room duration and patient satisfaction. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University-affiliated tertiary-care hospital. PATIENTS: 87 ASA physical status I and II adult patients scheduled for middle ear surgery. INTERVENTIONS: Patients were randomly assigned to receive one of the following interventions intravenously: ondansetron 4 mg (Group 1), promethazine 25 mg (Group 2), ondansetron 2 mg plus promethazine 12.5 mg (Group 3, combination), or placebo (Group 4). MEASUREMENTS AND MAIN RESULTS: Independent, study blinded observers recorded complaints of nausea and number of episodes of vomiting for 24 hours following the patient's first response to commands. All patients were contacted the day after discharge to inquire about nausea and vomiting. The awakening time, postanesthesia care unit and day surgery unit durations, opioid use, and side effects were recorded. At the end of the 24-hour period, the study blinded observers asked patients for an overall assessment of their global anesthesia experience using an 11-point scale. During the 24-hour period, the incidence of postoperative nausea and vomiting was reduced from 74% (placebo) to 39% (promethazine; p = 0.03) and 29% (combination; p = 0.003). Compared with placebo, the severity of vomiting was significantly less in the combination group (p = 0.04). The number of very satisfied patients correlated negatively with the incidence of postoperative nausea and vomiting (p < 0.0001) and with the severity of vomiting (p = 0.003). CONCLUSION: The prophylactic use of an antiemetic with middle ear surgery may reduce postoperative nausea and vomiting over 24 hours, and the ondansetron/promethazine combination or promethazine alone are cost-effective choices. Finally, the combination reduced significantly the severity of vomiting.

Hazards and Critical Control Points of Food Vending Operations in a City in Zambia.

Hazard analyses were conducted at several cooked food vending operations in a large city in Zambia, near a downtown bus park and at a large market. Samples of raw, processed, and cooked foods sold on streets or by small food shops were collected and tested for common foodborne pathogens and indicator organisms. Results showed that some raw foods (ground meat, chicken, chicken intestine) or processed foods (dried minnows; kapenta) were contaminated by salmonellae or contained high populations of Staphylococcus aureus (pasteurized milk) or Bacillus cereus (caterpillars). Cooking usually gave time-temperature exposures that would have been lethal for vegetative forms of foodborne pathogens. Holding of foods other than nshima often provided time-temperature exposures conducive to microbial growth, particularly in foods held overnight. Large populations of aerobic mesophilic organisms, thermotolerant coliform bacteria, and sometimes Escherichia coli were recovered from these foods. Ten million Clostridium peifringens per gram were isolated from a sample of leftover beef stew. Large populations (> 105) of S. aureus were recovered from a sample of leftover chicken, and large populations of B. cereus (> 107) were isolated from leftover rice. Time-temperature exposures during reheating had variable effects in terms of killing the microorganisms that germinated from surviving spores or that reached the foods after cooking, but heat-stable toxins would not have been inactivated.

Hazards and Critical Control Points of Food Preparation in Homes in Which Persons Had Diarrhea in Zambia.

Following identification of some cases of diarrhea from persons who either sought treatment at a health clinic that served two townships near a large city in Zambia or got water from a deep protected well in one of the townships, hazard analyses were done of food preparation and storage practices at 17 homes. Samples of foods at various stages of preparation, foods held overnight, and drinking water were collected from the homes of the ill persons and were tested for common foodborne pathogens and indicator organisms. Salmonella was isolated from a sample of leftover kapenta (cooked dried minnows). Thermotolerant coliforms and Escherichia coli were isolated from water from shallow wells and a treated community supply. Although thermtolerant coliforms were not recovered from the protected well site, they were isolated from a sample of water collected in a home that used this supply. Several leftover foods, however, contained much larger populations of thermotolerant coliforms and larger populations of aerobic mesophilic organisms than the water. Furthermore, leftover nshima (boiled and whipped corn meal) and porridge contained large populations (>105) of Bacillus cereus per gram. Foods during cooking attained temperatures that would have been lethal to vegetative cells of foodborne pathogens. After cooking, they were subjected to time-temperature abuse during holding until eaten or while held overnight.