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PubMed2000

Efficacy of ondansetron for prevention of postoperative nausea and vomiting after outpatient ear surgery under local anesthesia.

OBJECTIVE: To assess the efficacy and safety of intravenous ondansetron (4 mg) for the prevention of nausea and vomiting after middle ear surgery under local anesthesia. SETTING: The study was conducted by Division of Otorhinolaryngology in Prince of Wales Hospital, which is a tertiary referral center and teaching hospital for The Chinese University of Hong Kong. STUDY DESIGN: A double-blind randomized controlled trial. PATIENTS: Fifty-eight Chinese patients undergoing tympanoplasty under local anesthesia from July 1995 to June 1997 were recruited. The mean age of patients was 42.8 years (range 18-71 years). INTERVENTION: Patients were randomly allocated to receive a single dose of intravenous ondansetron (4 mg) (n = 29) or placebo (n = 29) immediately before surgery. MAIN OUTCOME MEASURES: Patients were assessed for severity and frequency of postoperative nausea and vomiting at the 1st, 2nd, 4th, 8th, and 24th hours after middle ear surgery. RESULTS: Female patients showed a higher prevalence of postoperative nausea and vomiting. Twenty-eight percent of the patients experienced postoperative nausea, of whom 14% also experienced vomiting. Although the ondansetron group demonstrated a lower prevalence of postoperative nausea and vomiting (PONV) (24% nausea and 10% vomiting) than the placebo group (31% nausea and 17% vomiting), significant reduction in postoperative vomiting only occurred in the first postoperative hour (p = 0.038). No complications or adverse side effects were found to be associated with the use of ondansetron. CONCLUSIONS: Single-dose ondansetron (4 mg) given intravenously preoperatively significantly reduces postoperative vomiting in patients after tympanoplasty under local anesthesia and causes no adverse effects.

Adolescent↗

PubMed2003

[A new vomiting animal model--mink].

AIM: To establish a new, reliable vomiting model in minks. METHODS: Adult male minks (Mustela vison) were randomly divided into groups (n = 6). Cisplatin, apomorphine, copper sulfate and X-radiation were used to establish vomiting model. Retching and vomiting were observed after the vomiting models were given anti-vomiting agents. After the behavioral experiment, assay of 5-HT in the ileum was performed by immunohistologic method. RESULTS: Cisplatin 7.5 mg.kg-1 i.p., apomorphine 1.6 mg.kg-1 s.c. and copper sulfate 40 mg.kg-1 ig were shown to evoke vomiting. Retching and vomiting were significantly inhibited in ondansetron and metoclopramide pretreated minks (P < 0.05, P < 0.01). CONCLUSION: As a new vomiting model, minks may be of great value in studying vomiting mechanism and screening new antiemetic drugs.

Animals↗

PubMed2005

Cancer chemotherapy-induced nausea and vomiting: role of mediators, development of drugs and treatment methods.

The development of serotonin 5-HT3 receptor antagonists dramatically improved the treatment of chemotherapy-induced nausea and vomiting. Ondansetron, a serotonin 5-HT3 receptor antagonist in combination with dexamethasone is widely used to treat chemotherapy-induced nausea and vomiting. This treatment regimen is effective against acute nausea and vomiting, but fails to control delayed nausea and vomiting. Metoclopramide along with other antiemetics are used to treat delayed nausea and vomiting. The high doses of metoclopramide needed may produce extra pyramidal side effects. The recent developments of 5-HT3 and dopamine D2 dual receptor antagonists have been found to exhibit a broad spectrum of activity against peripherally and centrally acting stimuli, but are not much effective against delayed emesis associated with chemotherapy. In various animal models, neurokinin NK1 receptor antagonists showed promising results against acute and delayed emesis, but the clinical trials revealed that triple therapy (NK1 receptor antagonist, 5-HT3 receptor antagonist and dexamethasone) is superior than standard therapy (5-HT3 receptor antagonist & dexamethasone) or NK1 receptor antagonist alone, in controlling acute as well as delayed nausea and vomiting. Ginger, which is used traditionally for controlling emesis induced by various stimuli, also showed good activity against chemotherapy-induced nausea and vomiting in animal models. Non-pharmacological methods such as acupressure and acustimulation are good adjunct methods in treating nausea and vomiting. Since many mediators are involved in emesis induced by chemotherapy, cocktail treatment is proven to be more efficacious than a single drug, but increases treatment costs. So there is a need of further research in this field to get economically useful methods for the treatment of acute and delayed chemotherapy-induced nausea and vomiting.

Animals↗

PubMed1985

Anticipatory nausea and vomiting in pediatric cancer patients.

The purpose of this study was to determine the prevalence and correlates of anticipatory nausea and vomiting in a sample of pediatric patients with cancer who were receiving outpatient chemotherapy. Forty male and female patients representing a broad range of diagnoses were interviewed with their parents concerning nausea and vomiting before and after chemotherapy. Anticipatory nausea was reported by 28.8% of the sample; anticipatory vomiting was present in 20% of the sample. An additional 9% had experienced anticipatory nausea and vomiting in the past but not currently. Anticipatory nausea and vomiting was positively correlated with the emetic potential of chemotherapeutic regimens and the severity of nausea and vomiting after chemotherapy; anticipatory nausea and vomiting most often developed within the first 4 months of treatment. Onset of anticipatory nausea and vomiting usually occurred two to four hours before treatment and was most severe at the actual time of drug administration. Considerable interpatient variability was observed, with treatment-related factors accounting for only 22% of the variance in the occurrence of anticipatory nausea and vomiting. These findings are considered within a behavioral framework for understanding conditioned aversions in pediatric patients with cancer. Implications for patient education, future research on the prediction of children at risk, and intervention are discussed.

Adolescent↗

PubMed1996

Differentiating cyclic from chronic vomiting patterns in children: quantitative criteria and diagnostic implications.

OBJECTIVE: To establish criteria to differentiate two patterns of vomiting and to identify the predominant diagnoses for each group. METHODS: All children 2 to 18 years of age referred to a pediatric gastroenterology service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (emeses per hour and episodes per month), diagnostic studies, and therapeutic responses were compared by Mann-Whitney U and chi-squared tests. RESULTS: Based on the criteria of peak intensity (four or more emeses per hour) and frequency (nine or fewer episodes per month), two subgroups were differentiated: chilcren with a cyclic pattern (n = 34), who vomited at a higher peak intensity (12.6 +/- 1.6 vs 1.5 +/- 0.1 emeses per hour) but at a lower frequency (1.9 +/- 4.8 vs 36.6 +/-0.3 episodes per month) than those with a chronic pattern (n = 72). Among children with a cyclic patern, nongastrointestinal (65%) causes, especially peptic and infectiouus disorders, predominated over nongastrointestinal ones (10%). CONCLUSIONS: On the basis of quantitative historical criteria, children with recurrent vomiting can be classified into two subgroups that seem to be clinically and etiologically distinct. Abdominal migraine was the dominant diagnosis in those with cyclic vomiting, whereas peptic and infectious gastrointestinal disorders predominated in those with chronic vomiting. This differentiation between cyclic and chronic patterns of vomiting may be a useful diagnostic clue to the clinician.

Child↗

PubMed1997

Nausea and vomiting in patients undergoing radiofrequency catheter ablation.

BACKGROUND: Radiofrequency catheter ablation is a technique for curing cardiac arrhythmias by destroying tissue that is a critical part of the targeted electrical circuit. Nausea and vomiting have been observed after use of this technique, but no study to date has examined these complications. OBJECTIVES: To determine the incidence of nausea and vomiting after radiofrequency catheter ablation, determine factors related to nausea and vomiting, and evaluate the antiemetic efficacy of promethazine given during the procedure. METHODS: Medical records for 369 cases of radiofrequency catheter ablation performed in a 4-year period at a university medical center were reviewed. RESULTS: Nausea after the procedure was documented in 22% of cases. Logistic regression analysis based on variables significant in bivariate analysis revealed that younger age, female sex, and longer procedure duration were significantly and independently related to nausea. Vomiting after the procedure occurred in 13% of cases. Logistic regression revealed that younger age and longer procedure duration were significantly and independently related to vomiting. Further analysis showed that patients who received larger doses of promethazine relative to the dose of fentanyl had a significantly lower incidence of vomiting. CONCLUSIONS: Nausea and vomiting occurred in a considerable number of cases. Female sex, younger age, and longer procedure duration increased the risk of nausea, whereas only age and procedure duration were associated with vomiting. This study may guide clinicians to use a prophylactic antiemetic in patients undergoing radiofrequency catheter ablation, especially patients at increased risk for nausea and vomiting.

Adolescent↗

PubMed2002

Nausea and Vomiting.

Nausea and vomiting are rather stereotyped symptoms. The challenge is that nausea and vomiting have many different causes and, in some patients, management may be rather complex. The clue is to determine the causal factor early. It helps to separate acute vomiting (<48 hours onset) from chronic vomiting. In acute vomiting, the causal factor or factors are most often evident. Symptomatic treatment with parenteral central-type antiemetics is the preferred treatment. Histamine-1 receptor antagonists, phenothiazines, butyrophenones, and corticosteroids are suitable drugs. For specific types of acute vomiting, for example, chemotherapy-related vomiting, the 5-HT3 receptor antagonists are costlier but effective drugs with minimal side effects. Sometimes, oral and parenteral administration of the above-mentioned drugs may be combined. The origin of chronic vomiting is often obscure, requires specialized investigation, and the causative factor may be uncorrectable. Symptomatic treatment requires a value judgement. If delayed gastric emptying is a contributing factor, prokinetic agents (metoclopramide, erythromycin, cisapride in special cases, if authorized) may prove useful. Otherwise, symptomatic treatment with central antiemetics is the only recourse. Some patients with unexplained vomiting present with psychological disturbances that act as magnifying or contributing factors and may be helped by psychotherapeutics.

Journal Article↗

PubMed2005

Chronic nausea and vomiting: new insights and approach to treatment.

Chronic vomiting of unclear etiology has been given a number of names over time. For many years, it was known as "psychogenic" vomiting because a psychiatric etiology was considered the most likely cause. More recently, the concepts of cyclic vomiting syndrome (CVS) and functional vomiting (FV) have been proposed to better explain this perplexing phenomenon. CVS is a dramatic clinical syndrome characterized by intense episodes of vomiting lasting over a period of days but alternating with periods of intense quiescence. FV, as defined by the Rome II diagnostic criteria, is vomiting of at least 3 months, which need not be consecutive, in the preceding year with at least three separate vomiting episodes in a week. It is found in the absence of obvious metabolic, structural, or psychiatric disorders which could explain the vomiting (Table 1). It will be the purpose of this article to review the history of chronic vomiting from a nomenclature perspective. Methodologic limitations of early studies will be described as well as more contemporary reviews that used updated methodologic approaches to describe this perplexing problem.

Journal Article↗

PubMed1983

Higher order neurons in buccal ganglia of Pleurobranchaea elicit vomiting motor activity.

The buccal mass of the gastropod Pleurobranchaea is used during a regurgitation response that consists of a writhing phase interrupted by brief periodic bouts of a vomiting phase (17, 20). During transitions from writhing to vomiting, specific changes occur in the motor pattern (19, 20). Evidence is presented suggesting that at least some of the initiation or "command" neurons for vomiting reside in the buccal ganglia. The present paper examines the role of two candidate vomiting-initiation cells, the ventral white cells (VWC) and midganglionic cells (MC), in the buccal ganglia of isolated nervous systems. Stimulation of single VWCs activates a vomiting motor pattern, consisting in part of alternating buccal root activity. Furthermore, the VWCs fire in high-frequency bursts during episodes (i.e., bouts) of this same vomiting pattern. Mutual reexcitation between the VWCs and motor pattern generator (MPG) appears to produce the accelerated buildup and maintenance of vomiting rhythms. Brief stimulation of single MCs "triggers" bouts of a vomiting motor pattern, but the membrane potential of this cell is only modulated during this same pattern, at least in the isolated nervous system. It is proposed that in intact animals the MCs are activated by sensory inputs and briefly excite the VWC-MPG network, thereby turning on the mutual reexcitatory mechanism mentioned above and switching the output pattern. A general implication for gastropod research is that higher order neurons that activate buccal root activity cannot automatically be given the function of "feeding command neuron," as some cells clearly control other responses, such as vomiting.

Animals↗

PubMed2001

Efficacy of gastric aspiration in reducing posttonsillectomy vomiting.

OBJECTIVE: To determine the effectiveness of postoperative gastric decompression in reducing the incidence and complications associated with vomiting following tonsillectomy. DESIGN: A prospective, randomized controlled study. SETTING: Private office and clinic of a university teaching hospital and research center. PATIENTS: Eighty pediatric patients ranging in age from 22 months to 11 years, American Society of Anesthesiologists class I or II, undergoing tonsillectomy with or without adenoidectomy were enrolled in the study. Six were excluded from the final analysis, 5 because of failure of the parents to complete and return the data forms and 1 because of postoperative bleeding. Of the 74 patients included in the study, 35 were in the control group and 39 were in the study group. INTERVENTIONS: The 39 patients in the study group underwent postoperative aspiration of gastric contents with an orogastric tube placed under direct visualization while the patient was still under general anesthesia. The 35 patients in the control group did not undergo gastric aspiration following surgery. MAIN OUTCOME MEASURES: The incidence of vomiting, the number of episodes of vomiting before and after hospital discharge, the total volume of emesis, the postoperative length of stay, the need for rescue antiemetic prophylaxis, and the number of readmissions to the hospital for persistent vomiting were noted. RESULTS: No statistically significant difference (P<.05) was noted between the control group and the study group for the percentage of patients experiencing vomiting (74% vs 85%), the mean number of episodes of vomiting before (2.6 vs 2.8) and after (0.8 vs 0.7) hospital discharge, the mean volume of emesis (157 mL vs 222 mL), the postoperative length of stay (394 minutes vs 334 minutes), the percentage of patients requiring rescue antiemetics (34% [12 patients] vs 33% [13 patients]), and the percentage of unplanned admissions because of vomiting (9% [3 patients] vs 15% [6 patients]). CONCLUSION: Our results indicate that gastric aspiration does not decrease the incidence of vomiting following tonsillectomy.

Child↗

PubMed2006

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.

BACKGROUND: Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics. OBJECTIVES: To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Members of the Cochrane UGPD Group were contacted for details of any ongoing or relevant unpublished clinical trials. SELECTION CRITERIA: Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects data was collected from the studies. MAIN RESULTS: Two trials involving 181 participants were included. Although no data were available for the precise time to cessation of vomiting (the primary outcome specified in the protocol for this review), one trial reported that the proportion of patients without vomiting over a 24 hour period was higher in the ondansetron and metoclopramide groups than placebo. In the second trial, ondansetron ensured complete anti-emesis for 8/12 (67%) patients within the first 4 hours and in 7/12 (58%) patients in the first 24 hr period. A few secondary outcomes were reported in the included trials. AUTHORS' CONCLUSIONS: The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.

Acute Disease↗

PubMed2005

Effects of Korean red ginseng extract on cisplatin-induced nausea and vomiting.

Ginseng, the root of Panax ginseng C.A. Meyer, is well known as a tonic medicine for restoring and enhancing human health. In traditional medicine, ginseng is utilized for the alleviation of emesis, which includes nausea and vomiting. However, it has not yet been demonstrated whether ginseng exhibits in vivo anti-nausea and anti-vomiting properties. In this study, we examined the anti-emetic effect of Korean red ginseng total extract (KRGE) on cisplatin-induced nausea and vomiting using ferrets. Intraperitoneal administration (i.p.) of cisplatin (7.5 mg/kg) induced both nausea and vomiting with one-hour latency. The episodes of nausea and vomiting reached a peak after 1.5 h and persisted for 3 h. Treatment with KRGE via oral route significantly reduced the cisplatin-induced nausea and vomiting in a dose-dependent manner. The anti-emetic effect was 12.7 +/- 8.6, 31.8 +/- 6.9, and 67.6 +/- 4.0% with doses of 0.3, 1.0, and 3.0 g/kg of KRGE, respectively. Pretreatment with KRGE via oral route 1 and 2 h before cisplatin administration also significantly attenuated the cisplatin-induced nausea and vomiting. However this did not occur with a pretreatment 4 h before cisplatin administration. These results are supportive of KRGE being utilized as an anti-emetic agent against nausea and vomiting caused by chemotherapy (i.e. cisplatin).

Animals↗

PubMed1991

The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle.

Postoperative nausea and vomiting is a major cause of postoperative morbidity. It can lead to increased recovery time, delaying patient discharge and an increase in hospital costs. Past studies have shown that postoperative nausea and vomiting is more frequent in women than men, appears to elevate around the time of menarche and is reduced around the time of menopause. This retrospective review of a one-year experience of laparoscopic tubal ligation at our institute examined the effect of menstrual cycle on postoperative nausea and vomiting. The anaesthetic and surgical techniques were consistent for all patients. Patient data included age, weight, last day of menstrual cycle, the length of anaesthetic, the dose of inhalational agent, the dose of narcotic, emesis on emergence and whether or not droperidol was used. Of the the 235 patients in the study, the incidence of nausea and vomiting was 28%. One hundred fifty-eight had had no preoperative antiemetic and 77 had received droperidol. These two groups were analyzed separately. The incidence in the group not receiving droperidol was 33.5% and in the droperidol group, 16.9% (P less than 0.01). The incidence of nausea and vomiting was higher on the first eight menstrual days (51.6 vs 21.6, P less than 0.001), was highest on day five of the menstrual cycle and lowest on days 18, 19, and 20 where there was no nausea and vomiting. Droperidol reduced the incidence of postoperative nausea and vomiting but the variation in postoperative nausea and vomiting during the cycle persisted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

A comparison of ondansetron and prochlorperazine for the prevention of nausea and vomiting after tympanoplasty.

PURPOSE: To evaluate the effects on PONV and headache after tympanoplasty of prochlorperazine 0.2 mg.kg-1 i.m., ondansetron 0.06 mg.kg-1 i.v. or placebo (isotonic saline) 0.02 ml.kg-1 i.v. given immediately after induction of anaesthesia prior to tracheal intubation. METHODS: The study was randomised, double blind and prospective. One hundred and forty-eight patients, aged 9-61 yr, received a standardised balanced inhalational anaesthetic with controlled ventilation and induced hypotension. Postoperatively, the frequencies of retching and vomiting in the PACU and of nausea, retching, vomiting, headache, analgesic and antiemetic requirements in the surgical ward for 24 hr were recorded. RESULTS: The four test groups (n = 37 each) were comparable. The incidences of vomiting in the PACU were similar. During the first 24 hr after surgery the antiemetics produced no reductions in the incidence of nausea alone or of vomiting alone. However, the combination of nausea and vomiting was reduced from 53% (placebo) to 16% (P < 0.0005), 19% (P < 0.0005) and 30% (P < 0.05) by i.m. prochlorperazine, i.v. ondansetron and i.v. prochlorperazine, respectively. The frequency of those experiencing no PONV was increased from 27% (placebo) by prochlorperazine i.m. to 57% (P < 0.01), by ondansetron i.v. to 62% (P < 0.005) and by prochlorperazine i.v. to 43% (P = NS). The onset of PONV was delayed in those given prochlorperazine im, and vomiting was less severe in those given ondansetron i.v. Headache occurred with similar frequency in each group. CONCLUSION: Prophylactic prochlorperazine 0.2 mg.kg-1 i.m. and ondansetron 0.06 mg.kg-1 i.v. are similarly efficacious in reducing nausea with vomiting after tympanoplasty, while prochlorperazine 0.1 mg.kg-1 i.v. is less efficacious. Neither drug given as described appeared to reduce the frequency of postoperative nausea alone or vomiting alone.

Adolescent↗

PubMed1998

The central pattern generator for vomiting may exist in the reticular area dorsomedial to the retrofacial nucleus in dogs.

There is some controversy over whether or not a discrete site that integrates vomiting activities in somatic and autonomic nerves is present in the medulla oblongata. On the basis of our previous studies, we hypothesized that the temporal patterns of muscle contractions in vomiting are generated by a central pattern generator in the retrofacial area of the rostral medulla. To investigate this hypothesis further, the effects of electrical and chemical lesions of the medullary area were observed in decerebrate paralyzed dogs. Efferent activities of the phrenic and abdominal muscle nerves were recorded to recognize fictive vomiting. The right half of the medulla oblongata was transversely severed about 3 mm rostral to the obex. Fictive vomiting responses to vagal stimulation still appeared after hemisection in all 11 dogs. In addition, stimulation of the contralateral reticular area dorsomedial to the retrofacial nucleus produced fictive vomiting even after hemisection. An electrical lesion or injection of kainic acid (0.5-1.0 microl) was applied at the point where reticular stimulation induced fictive vomiting. After this destruction, no activities that corresponded to fictive vomiting could be induced by stimulation of vagal afferents or the reticular site. Salivation was decreased by hemisection, and decreased further, but was not completely abolished, with destruction of the reticular area. Kainic acid is known to selectively destroy neural cell bodies. Therefore, we concluded that neuronal somata in the reticular formation dorsomedial to the retrofacial nucleus play an essential role in the central patterning of vomiting activities in peripheral motor nerves.

Animals↗

PubMed1998

The impact of postchemotherapy nausea and vomiting on quality of life after moderately emetogenic chemotherapy.

The purpose of the study was to assess the impact of postchemotherapy nausea and vomiting (PCNV) after moderately emetogenic chemotherapy on health-related quality of life (HRQOL) in patients with cancer being treated in a routine clinical practice setting. The European Organization for Research and Treatment in Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) was administered on day 2 and day 6 following moderately emetogenic chemotherapy to 119 patients with a variety of cancers. Patients kept daily diaries to record the occurrence and severity of nausea and vomiting. The QLQ-C30 questions were modified, for this study only, to assess the impact of nausea and vomiting on HRQOL in patients who experienced nausea and/or vomiting during the six days following chemotherapy. Those patients who experienced either nausea or vomiting experienced a decrease in HRQOL from prechemotherapy levels on six functioning and five symptom scales at day 2, and on four functioning and four symptom scales on day 6. Comparison of mean scores between the unmodified QLQ-30 and the nausea and vomiting versions demonstrated that the HRQOL rating attributed to nausea and vomiting accounted for much, but not all, of the deterioration in HRQOL scores in patients who experienced these symptoms. It can be concluded that patients who experience PCNV experience a significant negative impact on their HRQOL and that this impact can be attributed in large part to their experience of nausea and vomiting. However, since not all of the deterioration is attributable to these symptoms, other reasons for some of the decrease in HRQOL must also be identified in future studies.

Adult↗

PubMed1994

Possible involvement of peripheral 5-HT4 receptors in copper sulfate-induced vomiting in dogs.

The involvement of visceral afferent fibers and 5-HT3 or 5-HT4 receptors in the vomiting induced by oral administration of copper sulfate was investigated in beagle dogs. Vomiting induced by copper sulfate (100 mg/kg) was inhibited markedly by bilateral abdominal vagotomy and bilateral greater splanchnic nerve section. The vomiting induced by copper sulfate was inhibited by blocking 5-HT4 receptors with high doses (1 and 3 mg/kg, i.v.) of ICS 205-930. On the other hand, blocking 5-HT3 receptors with MDL 72222 (0.5 and 5 mg/kg, i.v.) or low doses (0.01 mg/kg i.v.) of ICS 205-930 had no apparent effect on the vomiting induced by copper sulfate. Oral administration of a 5-HT4 receptor agonist, 5-methoxytryptamine (5-MT), caused vomiting at a dose of 100 mg/kg, and the vomiting was inhibited markedly by abdominal visceral nerve section or a high dose (1 mg/kg, i.v.), but not a low dose (0.01 mg/kg, i.v.), of ICS 205-930. Intravenous administration of 5-MT (10 mg/kg) failed to induce vomiting. These results suggest that the abdominal visceral afferent fibers and possibly peripheral 5-HT4 receptors play an important role in the vomiting induced by oral administration of copper sulfate in dogs.

5-Methoxytryptamine↗

PubMed1989

The acute onset of nausea and vomiting following stereotactic radiosurgery: correlation with total dose to area postrema.

From 1986 to 1988, 44 patients have been treated for tumors or vascular lesions with stereotactic radiosurgery using a modified standard linear accelerator. In seven patients, nausea and vomiting occurred within 6 hours after the completion of radiosurgery. One of these patients with nausea and occasional vomiting pretreatment had exacerbation several hours after treatment, in spite of droperidol and prochlorperazine prophylaxis. Nausea and vomiting in the other six patients was self-limited and was completely resolved by 12 hours from onset. None of these six patients suffered from nausea and vomiting before treatment. This was directly correlated with the total dose to the vomiting center in the floor of the fourth ventricle (area postrema). The median dose to the vomiting center in the seven patients was 618 cGy (range 275-1257). The final patient in the series received 1088 cGy to the area postrema after droperidol and dexamethasone prophylaxis without developing nausea or vomiting. In the remaining 36 patients who received from less than 5 to 184 cGy to area postrema, nausea and vomiting did not occur. We recommend that patients treated with large fractions of radiation by radiosurgery in this area be premedicated appropriately.

Brain Neoplasms↗