ABSTRACT
One hundred and eighteen patients in whom postoperative gastrointestinal atony had lasted for 48-72 hours, were given one or two intravenous injections of different doses of cisapride (2, 4 or 8 mg), or vehicle. The first occurrence of flatus was taken to mark the cessation of ileus. There was no significant difference in remission of ileus between the groups in the first hour following injection. All patients not responding to treatment in the first hour were given a repeat dosage and observed for the following 3 hours. Among this group, there was a significant remission of ileus in patients who had received 2 X 8 mg, which was particularly marked in those who had undergone intraperitoneal surgery. This study suggests that cisapride in repeated dosage may be of value in inducing remission in prolonged surgical ileus, particularly in patients who have undergone intraperitoneal operations.
Subject(s)
Gastrointestinal Diseases/drug therapy , Gastrointestinal Motility/drug effects , Piperidines/therapeutic use , Postoperative Complications/drug therapy , Cisapride , Digestive System/physiopathology , Dose-Response Relationship, Drug , Female , Gastrointestinal Diseases/physiopathology , Humans , Intestinal Obstruction/drug therapy , Intestinal Obstruction/physiopathology , Male , Piperidines/adverse effects , Postoperative Complications/physiopathologyABSTRACT
The effect of 4 mg of the gastrointestinal motility enhancing agent cisapride on postoperative ileus was compared with that of a placebo in 53 patients who had undergone various types of surgery. They received one i.v. injection of the double-blind medication, or two if no distinct flatus occurred within an hour after the first injection. The placebo response was very limited; borborygmi or flatus did not occur in more than 12% of the patients not even after the second injection. Cisapride was significantly effective: bowel sounds were present in 43% and 50% within 1 hour after the first and second injection of 4 mg, respectively, and flatus in 36% and 43%. The recognition that colon inactivity probably is the major determinant of the ileus, may be indicative of a substantial relative impact of cisapride's stimulating effects on colon motility.
Subject(s)
Gastrointestinal Diseases/drug therapy , Gastrointestinal Motility/drug effects , Piperidines/therapeutic use , Postoperative Complications/drug therapy , Adult , Cisapride , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Intestinal Obstruction/drug therapy , MaleABSTRACT
Venous air embolism following urethral inflation only scarcely documented: an extensive search of the literature yielded four papers relating to this subject. We report a new case of venous air embolism due to this uncommon etiology. Careful study revealed some common pathogenetic features with previously reported cases. Some important precautions can diminish the likelihood of gas embolism and reduce its fatal outcome in situations, similar to the kind mentioned.
Subject(s)
Embolism, Air/etiology , Insufflation/adverse effects , Pulmonary Embolism/etiology , Urethra , Aged , Humans , Male , VeinsABSTRACT
Two cases are presented of an anaphylactoid reaction after intravenous drug injection. The first reaction immediately after the operation, the second during the induction. At the first sight it was not clear which substance was responsible. Therefore a technique was developed in cooperation with the Immunologic laboratory in order to diagnose exactly the causative antigen. This method is described.
Subject(s)
Antigens/analysis , Immune Complex Diseases/immunology , Complement System Proteins/analysis , Drug Hypersensitivity/diagnosis , Female , Humans , Immunoglobulins/analysis , Middle Aged , Neutrophils/immunology , Succinylcholine/immunology , Sulfamethoxazole/immunology , Trimethoprim/immunologyABSTRACT
In a double-blind comparison of domperidone 10 mg, domperidone 4 mg, metoclopramide 10 mg and a placebo, 176 adult patients were given an intravenous injection of one of these substances after postoperative vomiting had occurred. Patients were then observed for 6 hours. Those who failed to respond sufficiently to the double-blind injection were given an open dose of domperidone 4 mg i.v. Vomiting recurred in 52% of patients in each of domperidone groups compared with 75% of patients in the metoclopramide group and 84% of patients in the placebo group. Thus domperidone was significantly more effective than the other two substances (p < 0.05). Significantly more patients in the placebo group required a supplementary injection than in the domperidone and metoclopramide groups (p < 0.05). No side effects were observed in any patient.
Subject(s)
Antiemetics/therapeutic use , Benzimidazoles/therapeutic use , Metoclopramide/therapeutic use , Piperidines/therapeutic use , Postoperative Complications/drug therapy , Vomiting/drug therapy , Adult , Aged , Clinical Trials as Topic , Domperidone , Double-Blind Method , Female , Humans , Male , Middle Aged , Placebos , Vomiting/etiologyABSTRACT
Domperidone was compared with placebo in a multicenter double-blind study of 116 patients (15 to 80 years) with postoperative vomiting. After vomiting had occurred, the patients received either domperidone 10 mg or placebo IV. Patients were then followed for at least 6 hours or until a 2nd injection of domperidone 10 mg from an open supply was needed. The period of time until an additional injection was registered and compared between the 2 treatment groups. Fifty-nine percent of the placebo patients needed a 2nd injection before the end of the 6-hour follow-up, compared with only 35% of the domperidone patients (p less than 0.05). When a 2nd injection was required, the time elapsed before it was needed was longer (p = 0.01) in the domperidone group (median 150 minutes) than in the placebo one (median 120 minutes). There were no significant side-effects.
Subject(s)
Antiemetics/therapeutic use , Benzimidazoles/therapeutic use , Piperidines/therapeutic use , Postoperative Complications/prevention & control , Vomiting/prevention & control , Antiemetics/administration & dosage , Antiemetics/adverse effects , Benzimidazoles/administration & dosage , Benzimidazoles/adverse effects , Dose-Response Relationship, Drug , Double-Blind Method , Drug Evaluation , Humans , Piperidines/administration & dosage , Piperidines/adverse effects , PlacebosABSTRACT
The effect of domperidone on postoperative nausea and vomiting was evaluated in two consecutive studies. Fifty-eight patients with postoperative nausea and vomiting were included in an open pilot study and 38 other patients in a double-blind trial. In the first study 4 mg of domperidone was found to be significantly superior to 2 mg, in controlling nausea and vomiting. In the double-blind trial, vomiting recurred significantly later in domperidone than in placebo-treated patients. Side-effects were not seen nor reported in either study.
Subject(s)
Antiemetics/therapeutic use , Benzimidazoles/therapeutic use , Nausea/drug therapy , Piperidines/therapeutic use , Vomiting/drug therapy , Double-Blind Method , Female , Humans , Male , Postoperative ComplicationsABSTRACT
Cardiac contractility was studied in 4 groups of patients using, as parameter, the I/(PEP)2 index proposed by Reitan. 15 patients received 10 mg diazepam i.v. as sedation. The patients in group I were given lumbar peridural anesthesia with 20 ml prilocaine 2%. There was no significant change in the index. The patients in group II were given lumbar peridural anesthesia with 20 ml prilocaine and adrenalin 1/200,000. For 20 to 30 minutes there was a marked rise in the index. The patients in group III received the same lumbar peridural anesthesia as group II, but with a subsequent subcutaneous injection of 50 mg ephedrine HCl. At first the index rose rapidly; this rise was followed by a more rapid return to the initial value. Finally, the patients in group IV, who were under stabilized NLA narcosis, received 2 mg/kg prilocaine intravenously. There was no change in the index before and after the injection.
