Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic ...Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic databases and screened the retrieved studies using the inclusion and exclusion criteria.Data were then collated according to the types of interventions,measurement tool,and outcomes.Results:The search yielded 2343 records,of which 11 were included.Four categories of non-pharmacological CINV management were made;manipulative and body-based therapy(n=5 studies);mind–body therapy(n=3 studies);biologically based practice(n=1 study),and energy therapy(n=2 studies).Seven different scales were used to measure CINV.Nine studies repor ted improvement in CINV.Conclusions:This scoping review demonstrates the breadth of non-pharmacological management to address CINV.Various types of CINV scales were used to measure CINV severity.The management and scale can be utilized to improve nursing care,par ticularly in cancer care.展开更多
BACKGROUND Chemotherapy is the primary treatment for patients with advanced gastrointestinal cancer,but it has many adverse reactions,particularly nausea and vomiting.Music therapy can reduce anxiety symptoms,avoid th...BACKGROUND Chemotherapy is the primary treatment for patients with advanced gastrointestinal cancer,but it has many adverse reactions,particularly nausea and vomiting.Music therapy can reduce anxiety symptoms,avoid the response to the human body under various stress conditions through psychological adjustment,and improve the adverse reactions of chemotherapy.AIM To investigate the impact of music therapy on relieving gastrointestinal adverse reactions in chemotherapy for patients with digestive tract cancer by metaanalysis.METHODS EMBASE,PubMed,OVID,WoS,CNKI,CBM,and VIP database were all used for searching relevant literature,and the efficacy after treatment was combined for analysis and evaluation.RESULTS This study included seven articles.The results of meta-analysis indicated that music therapy could reduce the nausea symptom score of patients after chemotherapy[mean difference(MD)=-3.15,95%confidence interval(CI):-4.62 to-1.68,Z=-4.20,P<0.0001].Music therapy could reduce the vomiting symptom score of patients after chemotherapy(MD=-2.28,95%CI:-2.46 to-2.11,Z=-25.15,P<0.0001).Furthermore,music therapy could minimize the incidence of grade I and above nausea or vomiting in patients after chemotherapy(odds ratio=0.38,95%CI:0.26-0.56,Z=-4.88,P<0.0001).Meta-regression analysis found that publication year was not a specific factor affecting the combined results.There was no significant publication bias(P>0.05).CONCLUSION Music therapy can significantly improve the scores of nausea and vomiting symptoms in patients with digestive system cancer during chemotherapy and reduce the incidence of grade I and above nausea and vomiting after chemotherapy,making it an effective psychological intervention method worthy of clinical promotion.展开更多
Background: Chemotherapy?induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization(TACE). This study ai...Background: Chemotherapy?induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization(TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation(TEAS) on nausea and vomiting after TACE.Methods: A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active?acupuncture(n = 72) or placebo?acupuncture(n Hegu(LI4), Neiguan(P6), an= 70) groups using a covariate?adaptive randomization at a ratio of 1:1. The acupointsd Zusanli(ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory(MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.Results: Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant(all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active?acupuncture group than in the placebo?acupuncture group and continued to decrease over time with treat?ment(all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active?acupuncture group were slightly lower than those for the placebo?acupuncture group, but the differences were not statistically significant(all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event(P > 0.05).Conclusion: TEAS appears to be a safe and effective therapy to relieve patients' gastrointestinal discomfort after chemotherapy.展开更多
Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current gui...Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods: We searched the China Health Insurance Research Association(CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy(MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results: Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC(59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group(P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids(P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group(both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions: These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.展开更多
Objective: To describe the prescribing trends of antiemetics in chemotherapy-induced nausea and vomiting (CINV), assess adherence to American Society of Clinical Oncology (ASCO) guidelines, and evaluate the effectiven...Objective: To describe the prescribing trends of antiemetics in chemotherapy-induced nausea and vomiting (CINV), assess adherence to American Society of Clinical Oncology (ASCO) guidelines, and evaluate the effectiveness of prescribed antiemetics. Additionally, we also sought to explore barriers that hinder clinical practice guideline (CPG) implementation. Methods: One hundred fifty-five patients between the ages of 18 and 60 who were admitted to the haematology/oncology department/clinic to receive intravenous chemotherapy, either as in-patients or outpatients, were enrolled in a prospective observational study. Relevant patient demographic data, chemotherapy protocols and antiemetics were collected. Chemotherapies were classified according to their emetogenic potential. This information was used to assess whether the antiemetic prescribed matched the emetogenic risk of treatment. The analysis of outcomes was performed using the MASCC antiemetic assessment tool. Key Findings: The results showed that 95% of antiemetic prescription pre-chemotherapy regimens did not adhere to the guidelines. The findings were use of twice the recommended dose of granisetron (87.7%), overuse granisetron (16%) and metoclopramide (62.6%), and underuse dexamethasone (27%) and corticosteroid duplication (7.7%). With respect to post-chemotherapy antiemetic prescriptions, 91% of prescriptions were not adherent to guidelines, with overuse of granisetron (81.9%) and metoclpramide (34.2%) and underuse of dexamethasone (66.5%) being the most frequently reported trends. Conclusion: This study shows a lack of conformity to antiemetic guidelines, resulting mainly in overtreatment. Although vomiting was well-managed, nausea remains under controlled and requires additional medical attention. The lack of knowledge and motivation are considered barriers to CPG implementation.展开更多
Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinica...Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.展开更多
This paper presents the theoretical background of using auricular therapy(AT)for managing chemotherapy-induced nausea and vomiting(CINV)from the perspectives of traditional zang-fu organs and meridian theory.The zang-...This paper presents the theoretical background of using auricular therapy(AT)for managing chemotherapy-induced nausea and vomiting(CINV)from the perspectives of traditional zang-fu organs and meridian theory.The zang-fu organs of stomach,spleen and liver play a crucial role in regulating the gastrointestinal functions.The chemotherapeutic agents can significantly impede the gastrointestinal functions and subsequently contribute to various gastrointestinal symptoms including nausea and vomiting.Dysfunctions of the stomach,spleen and liver can correspond to specific auricular acupoints,while by stimulating those acupoints,the chaotic Qi movement can be reversed to its normal status,and the hyperactivities of the gastrointestinal system can also be alleviated to reduce the CINV symptoms.Clinical studies based on such theory have well supported the effects of AT on CINV.However,relationships between the traditional theory and the modern medicine understanding of the CINV mechanisms remain unknown and should be further explored in future research.展开更多
Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for ...Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting(CINV)in patients with solid malignant tumors,determine risk factors and externally validate different personalized risk models for CINV.Methods:This phase III trial was designed to test the non-inferiority of fosaprepitant toward aprepitant in cancer patients who were to receive the first cycle of single-day cisplatin chemotherapy.The primary endpoint was complete response(CR)during the overall phase(OP)with a non-inferiority margin of 10.0%.Logistic regression modelswere used to assess the risk factors ofCRand no nausea.To validate the personalized risk models,the accuracy of the risk scoring systems was determined by measuring the specificity,sensitivity and area under the receiver operating characteristic(ROC)curve(AUC),while the predictive accuracy of the nomogram was measured using concordance index(C-index).Results:A total of 720 patients were randomly assigned.CR during the OP in the fosaprepitant group was not inferior to that in the aprepitant group(78.1%vs.77.7%,P=0.765)with a between-group difference of 0.4%(95%CI,-5.7%to 6.6%).Female sex,higher cisplatin dose(≥70 mg/m2),no history of drinking and larger body surface area(BSA)were significantly associated with nausea.The AUC for the acute and delayed CINV risk indexes was 0.68(95%CI:0.66-0.71)and 0.66(95%CI:0.61-0.70),respectively,and the C-index for nomogram CINV prediction was 0.59(95%CI,0.54-0.64).Using appropriate cutoff points,the three models could stratify patients with high-or low-risk CINV.No nausea and CR rate were significantly higher in the low-risk group than in the high-risk group(P<0.001).Conclusions:Fosaprepitant-based triple prophylaxis demonstrated non-inferior control for preventing CINV in patients treated with cisplatin-base chemotherapy.Female cancer patients without a history of alcohol consumption,with larger BSA and received high-dose cisplatin might be more vulnerable to CINV.Three personalized prediction models were well-validated and could be used to optimize antiemetic therapy for individual patients.展开更多
Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms t...Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms that cause dissatisfaction among patients after anesthesia and surgery. A sub-hypnotic dose of propofol has been shown to reduce morphine-induced postoperative nausea, vomiting, and pruritus. This review article will provide sufficient knowledge on the role of propofol in minimizing opioid-induced postoperative nausea, vomiting, and pruritus by providing detailed information on propofol antiemetic and antipruritic effects, as well as discussions based on empirically available data. Method: We conducted a narrative review of the literature published between 1990 and 2023 from a range of databases;PubMed, BioMed Central, Biosis Previews, Nature, International Pharmaceutical Abstracts, Springer-Link, and Elsevier. Discussion and Conclusion: The literatures reviewed in this study have demonstrated that propofol may have diverse therapeutic effects including antiemetic and antipruritic. The antiemetic effect of propofol may be an effective therapeutic approach for the prevention of postoperative nausea and vomiting. The literature also demonstrated that the use of propofol for sedation during surgery may as well ameliorates opioids induced postoperative pruritus, which may be beneficial to surgical patients. Also, it was demonstrated that prophylactic use of propofol may be an effective way of preventing nausea and vomiting and pruritus during opioid use.展开更多
BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of ...BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.展开更多
Objective: To summarize the best evidence for the evaluation and management of chemotherapy-related nausea and vomiting in cancer patients, so as to promote the standardized management of chemotherapy-related nausea a...Objective: To summarize the best evidence for the evaluation and management of chemotherapy-related nausea and vomiting in cancer patients, so as to promote the standardized management of chemotherapy-related nausea and vomiting in cancer patients. Methods: A computer search was conducted for all evidence on chemotherapy-associated nausea and vomiting interventions, including guidelines, expert consensus, best clinical practice information booklet, recommended practice, evidence summary, and systematic review. The search period is from April 30, 2022. After the literature quality evaluation, the evidence extraction and summary of the literature meeting the quality standards. Results: A total of 16 literatures were included, including 9 guidelines, 5 systematic reviews and 2 expert consensus papers. 46 pieces of best evidence on the assessment and management of chemotherapy related nausea and vomiting in cancer patients were summarized, including 6 aspects including risk assessment and management, non-drug management, drug management, multidisciplinary cooperation, education and training, and health education. Conclusion: This study summarized the current best evidence on the assessment and management of chemotherapy-related nausea and vomiting in cancer patients. Clinical staff should apply evidence according to specific clinical scenarios, professional skills and patients’ wishes in order to reduce the degree and incidence of chemotherapy-related nausea and vomiting in cancer patients and improve the quality of care.展开更多
Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing...Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.展开更多
In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complicatio...In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complications has been gaining in popularity due to its low cost, simplicity, absence of side effects and confirmed efficacy. This study investigated the efficacy of stimulating the P6 acupoint in conjunction with the use of dexamethasone as prophylaxis for nausea and vomiting in pregnant women submitted to spinal anesthesia for a Cesarean section. The patients (n = 100) were randomly distributed into two groups. In the first group (n = 50), a site located one centimeter laterally from P6 was stimulated. This is not a true acupuncture point (sham acupuncture). In the second group (n = 50), P6 was stimulated. In both groups, 4 mg of dexamethasone were administered intravenously. A questionnaire was used to obtain information on the occurrence of nausea and vomiting during surgery and in the first 12 hours postpartum. The chi-square test and Fisher’s exact test were used to assess differences between the groups. Age and physical status were similar in both groups. The incidence of nausea during surgery was 32% (n = 16) in the control group and 22% (n = 11) in the P6 group (p > 0.05). In the first 12 hours following surgery, nausea occurred in 16% of the women in the control group (n = 6) and in 4% in the P6 group (n = 4) (p = 0.045). The incidence of vomiting in the control group was 12% (n = 6) during surgery and 10% (n = 5) in the postoperative period compared to 8% (n = 4) and 4% (n = 2), respectively, in the P6 group (p > 0.05). Although these differences were not statistically significant with the exception of the incidence of nausea in the first 12 hours postpartum, a reduction occurred in the incidence of all the outcomes evaluated in the P6 group.展开更多
Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically...Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.展开更多
However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criter...However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.展开更多
Cisplatin is commonly used in the treat-ment of cancers,but at the same time oftencauses side-effects like severe nausea andvomiting,which cannot be prevented ortreated satisfactorily with ordinary westernor tradition...Cisplatin is commonly used in the treat-ment of cancers,but at the same time oftencauses side-effects like severe nausea andvomiting,which cannot be prevented ortreated satisfactorily with ordinary westernor traditional Chinese drugs,thus hinderingthe chemotherapy from being carried outsmoothly.We tried several methods to tack-le the situation,and found that placing a flatpiece of magnetic disk on Neiguan pointhad a remarkable effect.The following is areport of our work.展开更多
Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemeti...Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.展开更多
Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for pos...Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.展开更多
Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable pa...Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).展开更多
基金supported by the Institute of Research and Innovation of Universitas Muhammadiyah Yogyakarta(No.034/PEN-LP3M/II/2021)。
文摘Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic databases and screened the retrieved studies using the inclusion and exclusion criteria.Data were then collated according to the types of interventions,measurement tool,and outcomes.Results:The search yielded 2343 records,of which 11 were included.Four categories of non-pharmacological CINV management were made;manipulative and body-based therapy(n=5 studies);mind–body therapy(n=3 studies);biologically based practice(n=1 study),and energy therapy(n=2 studies).Seven different scales were used to measure CINV.Nine studies repor ted improvement in CINV.Conclusions:This scoping review demonstrates the breadth of non-pharmacological management to address CINV.Various types of CINV scales were used to measure CINV severity.The management and scale can be utilized to improve nursing care,par ticularly in cancer care.
文摘BACKGROUND Chemotherapy is the primary treatment for patients with advanced gastrointestinal cancer,but it has many adverse reactions,particularly nausea and vomiting.Music therapy can reduce anxiety symptoms,avoid the response to the human body under various stress conditions through psychological adjustment,and improve the adverse reactions of chemotherapy.AIM To investigate the impact of music therapy on relieving gastrointestinal adverse reactions in chemotherapy for patients with digestive tract cancer by metaanalysis.METHODS EMBASE,PubMed,OVID,WoS,CNKI,CBM,and VIP database were all used for searching relevant literature,and the efficacy after treatment was combined for analysis and evaluation.RESULTS This study included seven articles.The results of meta-analysis indicated that music therapy could reduce the nausea symptom score of patients after chemotherapy[mean difference(MD)=-3.15,95%confidence interval(CI):-4.62 to-1.68,Z=-4.20,P<0.0001].Music therapy could reduce the vomiting symptom score of patients after chemotherapy(MD=-2.28,95%CI:-2.46 to-2.11,Z=-25.15,P<0.0001).Furthermore,music therapy could minimize the incidence of grade I and above nausea or vomiting in patients after chemotherapy(odds ratio=0.38,95%CI:0.26-0.56,Z=-4.88,P<0.0001).Meta-regression analysis found that publication year was not a specific factor affecting the combined results.There was no significant publication bias(P>0.05).CONCLUSION Music therapy can significantly improve the scores of nausea and vomiting symptoms in patients with digestive system cancer during chemotherapy and reduce the incidence of grade I and above nausea and vomiting after chemotherapy,making it an effective psychological intervention method worthy of clinical promotion.
基金supported by grants from the Shanghai Municipal Health Bureau Programs (No.2010L058A)the National Natural Science Foundation of China (No.81403248, No.81273955)
文摘Background: Chemotherapy?induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization(TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation(TEAS) on nausea and vomiting after TACE.Methods: A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active?acupuncture(n = 72) or placebo?acupuncture(n Hegu(LI4), Neiguan(P6), an= 70) groups using a covariate?adaptive randomization at a ratio of 1:1. The acupointsd Zusanli(ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory(MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.Results: Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant(all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active?acupuncture group than in the placebo?acupuncture group and continued to decrease over time with treat?ment(all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active?acupuncture group were slightly lower than those for the placebo?acupuncture group, but the differences were not statistically significant(all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event(P > 0.05).Conclusion: TEAS appears to be a safe and effective therapy to relieve patients' gastrointestinal discomfort after chemotherapy.
基金supported by MSD Holding Co.,Ltd.The funding was only for the payment of using CHIRA database
文摘Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods: We searched the China Health Insurance Research Association(CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy(MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results: Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC(59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group(P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids(P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group(both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions: These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
文摘Objective: To describe the prescribing trends of antiemetics in chemotherapy-induced nausea and vomiting (CINV), assess adherence to American Society of Clinical Oncology (ASCO) guidelines, and evaluate the effectiveness of prescribed antiemetics. Additionally, we also sought to explore barriers that hinder clinical practice guideline (CPG) implementation. Methods: One hundred fifty-five patients between the ages of 18 and 60 who were admitted to the haematology/oncology department/clinic to receive intravenous chemotherapy, either as in-patients or outpatients, were enrolled in a prospective observational study. Relevant patient demographic data, chemotherapy protocols and antiemetics were collected. Chemotherapies were classified according to their emetogenic potential. This information was used to assess whether the antiemetic prescribed matched the emetogenic risk of treatment. The analysis of outcomes was performed using the MASCC antiemetic assessment tool. Key Findings: The results showed that 95% of antiemetic prescription pre-chemotherapy regimens did not adhere to the guidelines. The findings were use of twice the recommended dose of granisetron (87.7%), overuse granisetron (16%) and metoclopramide (62.6%), and underuse dexamethasone (27%) and corticosteroid duplication (7.7%). With respect to post-chemotherapy antiemetic prescriptions, 91% of prescriptions were not adherent to guidelines, with overuse of granisetron (81.9%) and metoclpramide (34.2%) and underuse of dexamethasone (66.5%) being the most frequently reported trends. Conclusion: This study shows a lack of conformity to antiemetic guidelines, resulting mainly in overtreatment. Although vomiting was well-managed, nausea remains under controlled and requires additional medical attention. The lack of knowledge and motivation are considered barriers to CPG implementation.
文摘Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.
基金This paper is part of the work contained within the PhD thesis of Dr Jing-Yu Tan.Figures that are presented in this paper are derived and modified from the original thesis.Contents,presentation,styles of in-text citations and referencing list of the original chapter in the thesis have been partially modified and reorganised to fit the journal requirementThis work was supported by The Hong Kong Polytechnic University School of Nursing PhD scholarship.
文摘This paper presents the theoretical background of using auricular therapy(AT)for managing chemotherapy-induced nausea and vomiting(CINV)from the perspectives of traditional zang-fu organs and meridian theory.The zang-fu organs of stomach,spleen and liver play a crucial role in regulating the gastrointestinal functions.The chemotherapeutic agents can significantly impede the gastrointestinal functions and subsequently contribute to various gastrointestinal symptoms including nausea and vomiting.Dysfunctions of the stomach,spleen and liver can correspond to specific auricular acupoints,while by stimulating those acupoints,the chaotic Qi movement can be reversed to its normal status,and the hyperactivities of the gastrointestinal system can also be alleviated to reduce the CINV symptoms.Clinical studies based on such theory have well supported the effects of AT on CINV.However,relationships between the traditional theory and the modern medicine understanding of the CINV mechanisms remain unknown and should be further explored in future research.
文摘Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting(CINV)in patients with solid malignant tumors,determine risk factors and externally validate different personalized risk models for CINV.Methods:This phase III trial was designed to test the non-inferiority of fosaprepitant toward aprepitant in cancer patients who were to receive the first cycle of single-day cisplatin chemotherapy.The primary endpoint was complete response(CR)during the overall phase(OP)with a non-inferiority margin of 10.0%.Logistic regression modelswere used to assess the risk factors ofCRand no nausea.To validate the personalized risk models,the accuracy of the risk scoring systems was determined by measuring the specificity,sensitivity and area under the receiver operating characteristic(ROC)curve(AUC),while the predictive accuracy of the nomogram was measured using concordance index(C-index).Results:A total of 720 patients were randomly assigned.CR during the OP in the fosaprepitant group was not inferior to that in the aprepitant group(78.1%vs.77.7%,P=0.765)with a between-group difference of 0.4%(95%CI,-5.7%to 6.6%).Female sex,higher cisplatin dose(≥70 mg/m2),no history of drinking and larger body surface area(BSA)were significantly associated with nausea.The AUC for the acute and delayed CINV risk indexes was 0.68(95%CI:0.66-0.71)and 0.66(95%CI:0.61-0.70),respectively,and the C-index for nomogram CINV prediction was 0.59(95%CI,0.54-0.64).Using appropriate cutoff points,the three models could stratify patients with high-or low-risk CINV.No nausea and CR rate were significantly higher in the low-risk group than in the high-risk group(P<0.001).Conclusions:Fosaprepitant-based triple prophylaxis demonstrated non-inferior control for preventing CINV in patients treated with cisplatin-base chemotherapy.Female cancer patients without a history of alcohol consumption,with larger BSA and received high-dose cisplatin might be more vulnerable to CINV.Three personalized prediction models were well-validated and could be used to optimize antiemetic therapy for individual patients.
文摘Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms that cause dissatisfaction among patients after anesthesia and surgery. A sub-hypnotic dose of propofol has been shown to reduce morphine-induced postoperative nausea, vomiting, and pruritus. This review article will provide sufficient knowledge on the role of propofol in minimizing opioid-induced postoperative nausea, vomiting, and pruritus by providing detailed information on propofol antiemetic and antipruritic effects, as well as discussions based on empirically available data. Method: We conducted a narrative review of the literature published between 1990 and 2023 from a range of databases;PubMed, BioMed Central, Biosis Previews, Nature, International Pharmaceutical Abstracts, Springer-Link, and Elsevier. Discussion and Conclusion: The literatures reviewed in this study have demonstrated that propofol may have diverse therapeutic effects including antiemetic and antipruritic. The antiemetic effect of propofol may be an effective therapeutic approach for the prevention of postoperative nausea and vomiting. The literature also demonstrated that the use of propofol for sedation during surgery may as well ameliorates opioids induced postoperative pruritus, which may be beneficial to surgical patients. Also, it was demonstrated that prophylactic use of propofol may be an effective way of preventing nausea and vomiting and pruritus during opioid use.
基金The study was approved by the Ethics Committee of the First Affiliated Hospital of Dalian Medical University(PJ-KS-KY-2020-161[X]).
文摘BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.
文摘Objective: To summarize the best evidence for the evaluation and management of chemotherapy-related nausea and vomiting in cancer patients, so as to promote the standardized management of chemotherapy-related nausea and vomiting in cancer patients. Methods: A computer search was conducted for all evidence on chemotherapy-associated nausea and vomiting interventions, including guidelines, expert consensus, best clinical practice information booklet, recommended practice, evidence summary, and systematic review. The search period is from April 30, 2022. After the literature quality evaluation, the evidence extraction and summary of the literature meeting the quality standards. Results: A total of 16 literatures were included, including 9 guidelines, 5 systematic reviews and 2 expert consensus papers. 46 pieces of best evidence on the assessment and management of chemotherapy related nausea and vomiting in cancer patients were summarized, including 6 aspects including risk assessment and management, non-drug management, drug management, multidisciplinary cooperation, education and training, and health education. Conclusion: This study summarized the current best evidence on the assessment and management of chemotherapy-related nausea and vomiting in cancer patients. Clinical staff should apply evidence according to specific clinical scenarios, professional skills and patients’ wishes in order to reduce the degree and incidence of chemotherapy-related nausea and vomiting in cancer patients and improve the quality of care.
文摘Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.
文摘In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complications has been gaining in popularity due to its low cost, simplicity, absence of side effects and confirmed efficacy. This study investigated the efficacy of stimulating the P6 acupoint in conjunction with the use of dexamethasone as prophylaxis for nausea and vomiting in pregnant women submitted to spinal anesthesia for a Cesarean section. The patients (n = 100) were randomly distributed into two groups. In the first group (n = 50), a site located one centimeter laterally from P6 was stimulated. This is not a true acupuncture point (sham acupuncture). In the second group (n = 50), P6 was stimulated. In both groups, 4 mg of dexamethasone were administered intravenously. A questionnaire was used to obtain information on the occurrence of nausea and vomiting during surgery and in the first 12 hours postpartum. The chi-square test and Fisher’s exact test were used to assess differences between the groups. Age and physical status were similar in both groups. The incidence of nausea during surgery was 32% (n = 16) in the control group and 22% (n = 11) in the P6 group (p > 0.05). In the first 12 hours following surgery, nausea occurred in 16% of the women in the control group (n = 6) and in 4% in the P6 group (n = 4) (p = 0.045). The incidence of vomiting in the control group was 12% (n = 6) during surgery and 10% (n = 5) in the postoperative period compared to 8% (n = 4) and 4% (n = 2), respectively, in the P6 group (p > 0.05). Although these differences were not statistically significant with the exception of the incidence of nausea in the first 12 hours postpartum, a reduction occurred in the incidence of all the outcomes evaluated in the P6 group.
基金This study was supported by the Major projects of Sichuan Science and Technology Department of China (No.18ZDYF0347)Mianyang Science and Technology Bureau of China (No. 17YFHM008).
文摘Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.
基金This work was supported by the National Natural Science Foundation of China(No.81804180).
文摘However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.
文摘Cisplatin is commonly used in the treat-ment of cancers,but at the same time oftencauses side-effects like severe nausea andvomiting,which cannot be prevented ortreated satisfactorily with ordinary westernor traditional Chinese drugs,thus hinderingthe chemotherapy from being carried outsmoothly.We tried several methods to tack-le the situation,and found that placing a flatpiece of magnetic disk on Neiguan pointhad a remarkable effect.The following is areport of our work.
文摘Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.
文摘Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.
文摘Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).