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PubMed1999

Supplemental oxygen reduces the incidence of postoperative nausea and vomiting.

BACKGROUND: Despite new anesthetic drugs and antiemetics, particularly 5-hydroxytryptamines, the incidence of postoperative nausea or vomiting remains between 20% and 70%. The authors tested the hypothesis that supplemental perioperative oxygen administration reduces the incidence of postoperative nausea or vomiting. METHODS: Patients undergoing colon resection were anesthetized with fentanyl and isoflurane. During and for 2 h after surgery they were randomly assigned to (1) 30% oxygen, balance nitrogen (n = 119); or (2) 80% oxygen, balance nitrogen (n = 112). The incidence of nausea or vomiting during the first 24 postoperative hours was evaluated by nurses blinded to group assignment and oxygen concentration. Data were analyzed with unpaired t or Mann-Whitney U tests. Results are presented as means +/- SD; P < 0.05 was considered significant. RESULTS: Factors known to influence nausea and vomiting were comparable in the two groups. Perioperative oxygen saturation was well within normal limits in each treatment group; saturations the first postoperative morning were comparable in each group. Supplemental oxygen reduced the incidence of postoperative nausea or vomiting from 30% in the patients given 30% oxygen to 17% in those given 80% oxygen (P = 0.027). CONCLUSIONS: Supplemental oxygen reduced the incidence of postoperative nausea or vomiting nearly twofold after colorectal surgery. The mechanism by which oxygen administration reduces the incidence of these postoperative sequelae remains unknown but may be related to subtle intestinal ischemia. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen appears to be an effective method of reducing postoperative nausea and vomiting.

Aged↗

PubMed1987

Vomiting after ophthalmic surgery. Effects of intra-operative antiemetics and postoperative oral fluid restriction.

The usefulness of intra-operative antiemetics and postoperative oral fluid restriction in the prevention of vomiting following anaesthesia for ophthalmic surgery, was studied in 200 patients. They were allocated into four groups of 50 and given either saline (as control), droperidol, metoclopramide or prochlorperazine. Oral intake was restricted postoperatively in half of the patients of each group. Anaesthesia comprised morphine and atropine premedication and a halothane, nitrous oxide and oxygen spontaneous breathing technique. No significant beneficial effects resulted from intra-operative antiemetics; vomiting incidences of 26% after saline and droperidol, 28% after metoclopramide and 14% after prochlorperazine were observed. Younger patients and females vomited most frequently. Restriction of oral fluids did not decrease the incidence of vomiting but demonstrated that approximately half of those patients who vomit do so with their first postoperative oral intake. Vomiting was observed more frequently after non intra-ocular surgery than after intra-ocular surgery (37% cf. 16%, p less than 0.01) and postoperative analgesics were required by more non intra-ocular patients than by intra-ocular patients (25% cf. 5%, p less than 0.001). Squint patients vomited most frequently (48%) and most frequently required postoperative analgesia (35%).

Adult↗

PubMed1994

Risk factors for postoperative nausea and vomiting.

Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. Intravenous anaesthetics are also associated with differing degrees of emesis, though the newer agent, propofol, may be less emetogenic than the older anaesthetics. Opioids, used extensively throughout surgery, are further strong emetogens. Patient factors are also important--postoperative nausea and vomiting is three times more prevalent in adult females than in males, and children are around twice as susceptible as adults. Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery--abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.

Adolescent↗

PubMed1996

Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting.

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.

Female↗

PubMed1997

Does propofol reduce vomiting after strabismus surgery in children?

BACKGROUND: Previous studies have indicated that propofol anaesthesia may reduce the incidence of postoperative nausea and vomiting after strabismus surgery in children. This study was designed to investigate the incidence of vomiting after strabismus surgery at two different levels of propofol anaesthesia compared to thiopental/isoflurane anaesthesia. METHODS: Ninety ASA class I or II children, aged 5-14 yrs were randomly assigned to one of three groups: Group T/I (n = 30) induction with 5 mg kg-1 of thiopental and maintenance with isoflurane, group P5 (n = 31) induction with propofol 2 mg kg-1, maintenance with propofol infusion 5 mg kg-1 h-1 or group P10 (n = 29) induction with propofol 2 mg kg-1, maintenance with propofol 10 mg kg-1 h-1. All received glycopyrrolate, vecuronium, fentanyl and controlled ventilation with O2/N2O 30/70. Ketorolac i.v. was given to prevent postoperative pain. If additional analgesia was needed, ibuprofen/acetaminophen or buprenorphine was given according to clinical need. RESULTS: There were no differences between study groups with respect to age, weight, history of previous anaesthesia or emesis after previous anaesthesia, duration of anaesthesia, surgery or sleep after anaesthesia, or number of muscles operated. The incidence of vomiting was 37%, 29% and 28% in groups T/I, P5 and P10, respectively. There were no statistically significant differences between the three groups in the incidence of vomiting. The median age of patients who vomited was 7.5 (range 5.0-13.7) yrs while the median age of the patients who did not vomit was 9.1 (range 5.0-14.0) yrs (P < 0.01). CONCLUSION: In the present study, propofol anaesthesia compared to thiopental/isoflurane anaesthesia did not reduce the incidence of vomiting following strabismus surgery in children.

Adolescent↗

PubMed2003

Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy.

PURPOSE: To test whether nausea and vomiting or fatigue correlated with psychosocial variables. DESIGN: Descriptive, using secondary data from a prenatal database of 113 women in prenatal care in Texas. Mean gestational duration was 59 days at the time of data collection. METHODS: Psychosocial factors, frequency of nausea and vomiting and of fatigue were determined by use of questionnaires. Psychosocial measures had reliability and validity and included the Personal Resources Questionnaire and Center for Epidemiologic Studies Depression Scale. A checklist was used for measuring nausea and vomiting and fatigue. FINDINGS: Of 113 participants, 30 (26.5%) reported no, 43 (38.1%) occasional, and 40 (35.4%) frequent nausea and vomiting. Depressive symptoms had the highest correlation with nausea and vomiting. Social support was negatively related to nausea and vomiting. Four (3.5%) women reported no fatigue, 49 (43.4%) reported occasional fatigue, and 60 (53.1%) reported frequent fatigue in the past month. Depressive symptoms had the highest correlation with fatigue. The chi-square statistic showed that fatigue was significantly related to employment. Fatigue was not significantly associated with work hours or stressfulness of jobs. CONCLUSIONS: Only a limited number of psychosocial factors were associated with nausea and vomiting and fatigue in early pregnancy. Depression was related to physical symptoms, but unclear was whether depression preceded or resulted from the symptoms. Many women experienced symptoms, and better understanding of causality is needed to ameliorate the effects on women's well-being.

Adolescent↗

PubMed1988

The role of the abdominal visceral innervation and 5-hydroxytryptamine M-receptors in vomiting induced by the cytotoxic drugs cyclophosphamide and cis-platin in the ferret.

We have used the ferret as an animal model to investigate the emetic action of the cytotoxic drugs cyclophosphamide and cis-platin. Using selective nerve lesions, a crucial role for the abdominal innervation in the genesis of retching and vomiting in response to these agents has been demonstrated. A combination of bilateral abdominal vagotomy and greater splanchnic nerve section can totally abolish retching and vomiting in response to intraperitoneal cis-platin or intravenous cyclophosphamide. Intraperitoneal cyclophosphamide still produced retching but vomiting was markedly reduced, demonstrating complex and probably separate control mechanisms for retching and vomiting. The effect of a widely used anti-emetic, metoclopramide, was compared to that of nerve lesions. While effective this compound did not totally control retching or vomiting to either drug. Recent studies have attributed metoclopramide's action to its ability to antagonize 5-HT M-receptors (5-HT-3 receptors). Therefore we investigated BRL 24924, a gastro-kinetic agent with more specific 5-HT M-receptor antagonist properties. This agent was extremely potent in almost totally abolishing retching and vomiting in response to cyclophosphamide, given by either an intravenous or intraperitoneal route, and totally abolished cis-platin-induced vomiting for at least 4 h. Clearly the abdominal visceral innervation plays a complex and major role in the emesis produced by these two cytotoxic drugs; circumstantial evidence suggests that 5-HT M-receptors on visceral afferent nerves mediate this action, but other possibly central sites of action of the 5-HT M-receptor antagonists cannot be excluded.

Animals↗

PubMed1990

Respiratory muscle control during vomiting.

The changes in thoracic and abdominal pressure that generate vomiting are produced by coordinated action of the major respiratory muscles. During vomiting, the diaphragm and external intercostal (inspiratory) muscles co-contract with abdominal (expiratory) muscles in a series of bursts of activity that culminates in expulsion. Internal intercostal (expiratory) muscles contract out of phase with these muscles during retching and are inactive during expulsion. The periesophageal portion of the diaphragm relaxes during expulsion, presumably facilitating rostral movement of gastric contents. Recent studies have begun to examine to what extent medullary respiratory neurons are involved in the control of these muscles during vomiting. Bulbospinal expiratory neurons in the ventral respiratory group caudal to the obex discharge at the appropriate time during (fictive) vomiting to activate either abdominal or internal intercostal motoneurons. The pathways that drive phrenic and external intercostal motoneurons during vomiting have yet to be identified. Most bulbospinal inspiratory neurons in the dorsal and ventral respiratory groups do not have the appropriate response pattern to initiate activation of these motoneurons during (fictive) vomiting. Relaxation of the periesophageal diaphragm during vomiting could be brought about, at least in part, by reduced firing of bulbospinal inspiratory neurons.

Animals↗

PubMed1992

Membrane potential changes of phrenic motoneurons during fictive vomiting, coughing, and swallowing in the decerebrate cat.

1. The patterns of membrane potential changes of phrenic motoneurons were compared during fictive vomiting, fictive coughing, and fictive swallowing in decerebrate, paralyzed cats. These fictive behaviors were identified by motor nerve discharge patterns similar to those recorded from the muscles of nonparalyzed animals. Phrenic motoneurons (n = 54) were identified by antidromic activation from the thoracic phrenic nerve. Intracellular recordings were obtained from 27 motoneurons during fictive vomiting, 40 during fictive coughing, and 27 during fictive swallowing. Sixteen motoneurons were recorded during both fictive coughing and fictive swallowing, eight during both fictive coughing and fictive vomiting, and two during both fictive vomiting and fictive swallowing. Seven motoneurons were studied during all three behaviors. 2. Fictive vomiting, typically evoked by electrical stimulation of abdominal vagal afferents, was characterized by a series of bursts of coactivation of phrenic and abdominal motor nerves, culminating in an expulsion phase in which abdominal discharge was prolonged both with respect to phrenic discharge and to abdominal discharge during the preceding retching phase. During fictive vomiting, phrenic motoneurons depolarized abruptly, and the amplitude of depolarization was significantly greater than during control inspirations. They then repolarized slowly throughout the phrenic burst, rapidly repolarizing at the end of each phrenic burst during retching and reaching a level similar to that observed during expiration. During the expulsion phase, the pattern was initially the same. However, after the cessation of phrenic discharge, the membrane potential repolarized slowly until the end of the abdominal burst, exhibiting greater synaptic noise than during expiration. One phrenic motoneuron, presumably innervating the periesophageal region of the diaphragm, received a strong hyperpolarization just before the onset of the emetic episode and fired for shorter periods during fictive vomiting than did other phrenic motoneurons.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1998

Genetic epidemiology of binging and vomiting.

BACKGROUND: Bulimia nervosa is typically defined as the combination of the behaviours of binging and vomiting. We sought to clarify the relationship of these behaviours from a genetic epidemiological perspective. METHOD: Using data on the lifetime history of binging and vomiting from a personally interviewed population-based sample of female twins (n = 1897), we applied bivariate twin modelling to estimate the sources of variation for these traits. RESULTS: The association between having ever binged (23.6%) and having ever induced vomiting (4.8%) was very strong (odds ratio = 8.78, P << 0.0001). The best-fitting model indicated that lifetime binging and vomiting were both heritable (46% and 72%) and influenced by individual-specific environmental factors (54% and 28%). The overlap between the genetic (ra = 0.74) and individual-specific environmental factors (re = 0.48) for the two traits was substantial. No violations of the equal environmental assumption were evident. CONCLUSIONS: Including binging and vomiting under the rubric of bulimia nervosa appears to be appropriate. Our data are consistent with the identification of binging and vomiting as complex traits resulting from the interplay of multiple genes and individual-specific environmental influences. In contrast to 'environmentalist' theories, our results suggest that genetic influences may be of particular relevance to the aetiology of binging and vomiting.

Adult↗

PubMed1994

Efficacy and safety of granisetron, a selective 5-hydroxytryptamine-3 receptor antagonist, in the prevention of nausea and vomiting induced by high-dose cisplatin.

PURPOSE: To assess the antiemetic effects and safety profile of four different doses of granisetron (Kytril; SmithKline Beecham Pharmaceuticals, Philadelphia, PA) when administered as a single intravenous (IV) dose for prophylaxis of cisplatin-induced nausea and vomiting. PATIENTS AND METHODS: One hundred eighty-four chemotherapy-naive patients receiving high-dose cisplatin (81 to 120 mg/m2) were randomized to receive one of four granisetron doses (5, 10, 20, or 40 micrograms/kg) administered before chemotherapy. Patients were observed on an inpatient basis for 18 to 24 hours, and vital signs, nausea, vomiting, retching, and appetite were assessed. Safety analyses included incidence of adverse experiences and laboratory parameter changes. RESULTS: After granisetron doses of 5, 10, 20, and 40 micrograms/kg, a major response (< or = two vomiting or retching episodes, and no antiemetic rescue) was recorded in 23%, 57%, 58%, and 60% of patients, respectively, and a complete response (no vomiting or retching, and no antiemetic rescue) in 18%, 41%, 40%, and 47% of patients, respectively. There was a statistically longer time to first episode of nausea (P = .0015) and vomiting (P = .0001), and fewer patients were administered additional antiemetic medication in the 10-micrograms/kg dosing groups than in the 5-micrograms/kg dosing group. As granisetron dose increased, appetite return increased (P = .040). Headache was the most frequently reported adverse event (20%). CONCLUSION: A single 10-, 20-, or 40-micrograms/kg dose of granisetron was effective in controlling vomiting in 57% to 60% of patients who received cisplatin at doses greater than 81 mg/m2 and totally prevented vomiting in 40% to 47% of patients. There were no statistically significant differences in efficacy between the 10-micrograms/kg dose and the 20- and 40-micrograms/kg doses. Granisetron was well tolerated at all doses.

Adolescent↗

PubMed2005

Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.

PURPOSE: Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. MATERIALS AND METHODS: Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model. RESULTS: Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = -0.19; 95% CI, -0.38 to -0.01; P = .03) and most severe acute nausea, but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. CONCLUSION: This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

Acupuncture Points↗

PubMed2004

Prophylaxis of postoperative nausea and vomiting with oral, long-acting dimenhydrinate in gynecologic outpatient laparoscopy.

UNLABELLED: Dimenhydrinate is an inexpensive antiemetic with few side effects available as an oral, long-acting (LA) formulation (Gravol L/A) containing 25 mg of immediate and 50 mg of sustained release drug. We designed this double-blind comparison trial to assess the efficacy of dimenhydrinate LA versus droperidol alone and the combination for prophylaxis of nausea, vomiting, and retching in outpatient gynecologic laparoscopy. One-hundred-forty-one women were randomized into 3 groups: 1) droperidol (placebo capsule preoperatively and IV droperidol 0.625 mg before induction), 2) dimenhydrinate LA preoperatively and IV placebo before induction, or 3) combination. Information regarding nausea, vomiting, retching, pain, and sedation was recorded in the postanesthesia care unit (PACU) and collected by telephone for the presence of symptoms: on arrival home; at bedtime; upon arising, and at lunchtime the following day. The overall incidence of complete treatment failure (rescue medication in PACU or nausea, vomiting, or retching at any time point) was 28 of 46 (61%), 28 of 48 (58%), and 22 of 47 (47%); and for treatment failure vomiting (rescue medication in PACU or vomiting or retching at any time point) was 16 of 46 (35%), 11 of 48 (23%), and 5 of 47 (11%), for the droperidol, dimenhydrinate, and combination groups, respectively (P = 0.007 for droperidol versus combination). There were no differences in sedation or pain. Preoperative administration of an oral dose of LA dimenhydrinate in combination with droperidol when compared with droperidol alone effectively reduced the incidence of vomiting but not nausea in women undergoing elective outpatient gynecologic laparoscopy. IMPLICATIONS: Dimenhydrinate is an inexpensive antiemetic with few side effects available as a long-acting oral formulation. Women undergoing outpatient gynecologic laparoscopy were given droperidol, an effective antiemetic, dimenhydrinate alone, or the combination of the two drugs. Dimenhydrinate plus droperidol significantly reduced the overall incidence of vomiting, but not nausea, when compared with droperidol alone.

Administration, Oral↗

PubMed2005

Continuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Aged↗

PubMed2005

Does neostigmine administration produce a clinically important increase in postoperative nausea and vomiting?

Neostigmine is used to antagonize neuromuscular blocker-induced residual neuromuscular paralysis. Despite the findings of a previous meta-analysis, the effect of neostigmine on postoperative nausea and vomiting remains unresolved. We reevaluated the effect of neostigmine on postoperative nausea and vomiting while considering the different anticholinergics as potentially confounding factors. We performed a systematic literature search using MEDLINE, Embase, Cochrane library, reference listings, and hand searching with no language restriction through December 2004 and identified 10 clinical, randomized, controlled trials evaluating neostigmine's effect on postoperative nausea and vomiting. Data on nausea or vomiting from 933 patients were extracted for the early (0-6 h), delayed (6-24 h), and overall (0-24 h) postoperative periods and analyzed with RevMan 4.2 (Cochrane Collaboration, Oxford, UK) and multiple logistic regression analysis. The combination of neostigmine with either atropine or glycopyrrolate did not significantly increase the incidence of overall (0-24 h) vomiting (relative risk, 0.91; 95% confidence interval, 0.70-1.18; P = 0.48) or nausea (relative risk, 1.24; 95% confidence interval, 0.98-1.59; P = 0.08). Multiple logistic regression analysis indicated that there was not a significant increase in the risk of vomiting with large compared with small doses of neostigmine. Contrasting a previous analysis, we conclude that there is insufficient evidence to conclude that neostigmine increases the risk of postoperative nausea and vomiting.

Humans↗

PubMed1994

Granisetron. An update of its therapeutic use in nausea and vomiting induced by antineoplastic therapy.

Granisetron is a selective serotonin3 (5-hydroxytryptamine3, 5-HT3) receptor antagonist which has significant antiemetic activity against chemotherapy-induced nausea and vomiting. A single prophylactic intravenous dose is sufficient to control acute nausea and vomiting in approximately 60 to 70% of patients. In comparative studies, the acute antiemetic efficacy of granisetron is equivalent or superior to that of traditional antiemetic regimens even in patients receiving highly emetogenic cisplatin-containing chemotherapy. However, limited data have suggested that granisetron therapy offers no advantages over traditional antiemetics in terms of the control of delayed emesis. Recently, a number of large randomised studies have directly compared the efficacy and tolerability of granisetron, ondansetron and tropisetron and reported no significant differences between the 3 drugs in controlling acute nausea and vomiting, although 1 study reported a modest statistical advantage for granisetron over ondansetron but not tropisetron in the complete control of vomiting. In crossover studies, significantly more patients preferred granisetron to either ondansetron or tropisetron. The efficacy of granisetron appears to be maintained with repeated doses over several cycles of chemotherapy, although the influence of various prognostic factors affecting antiemetic response has not been adequately analysed. Concomitant administration of dexamethasone significantly improves the acute antiemetic efficacy of granisetron, increasing response rates by approximately 15%. Granisetron is an effective antiemetic in children undergoing highly emetogenic chemotherapy, and effectively controls radiotherapy-induced and postoperative nausea and vomiting. Trials using an oral formulation are scarce at present, but preliminary results suggest a similar efficacy and tolerability profile to that of the intravenous formulation. Granisetron has been well tolerated in clinical trials. The most frequently reported adverse event has been headache (14%). Extrapyramidal effects, which can limit the use of traditional antiemetics such as metoclopramide, have not been reported with granisetron. Thus, recent data confirm that granisetron is an effective and well tolerated agent for the prophylactic treatment of chemotherapy-induced acute nausea and vomiting, with efficacy equivalent or superior to that of other currently available agents. It has a promising role to play in paediatric oncology, and is an effective agent in controlling radiotherapy-induced acute emesis. Granisetron offers comparable or superior efficacy in controlling acute nausea and vomiting with a much simpler dosage regimen than that of traditional antiemetic regimens.

Adult↗

PubMed1996

Psychogenic vomiting complicated by marijuana abuse and spontaneous pneumomediastinum.

OBJECTIVE: This case illustrates an unusual physical sequel of psychogenic vomiting. CLINICAL PICTURE: A 22-year-old man with a picture of psychogenic vomiting and marijuana use developed the complications of a pneumomediastinum and subcutaneous emphysema. TREATMENT: Therapy included gradual exposure to anxiety provoking stimuli, psychotropics to reduce vomiting and psychotherapeutic exploration of family relationships. OUTCOME: The patient's vomiting and physical state resolved without complication. Follow-up at 12 months revealed continued improvement with occasional less severe vomiting. CONCLUSIONS: Psychogenic vomiting as a manifestation of anxiety can result in serious physical and psychological sequelae. This patient's desperate attempts to control such vomiting complicated the picture. Successful short term intervention included the use of several treatment modalities.

Adult↗

PubMed1999

Cyclic vomiting syndrome: features to be explained by a pathophysiologic model.

Cyclic vomiting syndrome is a disorder of unknown etiology that is characterized by its clinical pattern of rapid-fire, episodic (on-off) vomiting with interval wellness. The pattern is stereotypic within individuals and typified by a rapid onset during the night or early morning, rapid denouement, and associated symptoms of pallor, lethargy, anorexia, nausea, retching, vomiting, and abdominal pain. The vomiting appears to be triggered by a variety of physical and psychological stresses. The disorder usually begins in toddlers and resolves during adolescence. By definition, cyclic vomiting syndrome is an idiopathic disorder that requires exclusionary laboratory testing. Not only can it be mimicked by many specific disorders, eg, surgical, neurologic, endocrine, metabolic, renal, but within idiopathic cyclic vomiting syndrome there may be specific subgroups that have different mechanisms. Treatment options are improving at present and serotonergic agents have the most promise. Although the pathogenesis is unknown, there are now several tenable mechanisms including migraine, metabolic, neuroendocrine, and gastrointestinal. Cyclic vomiting syndrome may be a useful model for the study of emesis.

Adolescent↗