BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of ...BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.展开更多
Objective:To investigate the role of acupressure therapy in helping pregnant women with HG reduce the frequency or severity of vomiting and relieve stress and anxiety.Method:A quantitative study with a quasi-experimen...Objective:To investigate the role of acupressure therapy in helping pregnant women with HG reduce the frequency or severity of vomiting and relieve stress and anxiety.Method:A quantitative study with a quasi-experimental design and non-equivalent group design was used.Sixty-six valid data points were obtained from pregnant mothers diagnosed with HG in a general hospital in Linyi City.These pregnant women received either acupressure(n=33)or general therapeutic care(n=33).They completed standardized questionnaires designed to assess vomiting,anxiety,and stress levels.Results:Data showed no differences between the experimental and control groups before the intervention.After the intervention,there were significant differences in anxiety(P≤0.05)and stress(P≤0.05)scores between the two groups.However,there was no significant difference in vomiting scores(P>0.05)between the two groups after the intervention.The anxiety and stress scores of the experimental group were significantly lower than those of the control group post-intervention,while the vomiting scores of the two groups were similar.Conclusion:The findings suggest that acupressure significantly reduces anxiety and stress in pregnant women with hyperemesis gravidarum(HG)and also helps reduce vomiting.Acupressure presents a viable clinical option for pregnant women seeking relief from HG symptoms.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...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 emetogenie 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 eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties 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
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 Ganglioneuroma (GN) is a rare neurogenic tumor that accounts for about 0.1%- 0.5% of all tumors of the nervous system.It originates from neural crest cells.GN has no specific clinical symptoms or laboratory...BACKGROUND Ganglioneuroma (GN) is a rare neurogenic tumor that accounts for about 0.1%- 0.5% of all tumors of the nervous system.It originates from neural crest cells.GN has no specific clinical symptoms or laboratory findings,which leaves it easily overlooked and misdiagnosed as other tumors.Retroperitoneal GN with very large volume and vascular penetration is extremely rare.CASE SUMMARY We present the imaging and pathological findings of a giant retroperitoneal GN in a child.A 4-year-old boy had suffered from postprandial vomiting for more than 6 mo with no precipitating factors.Abdominal computerized tomographic examination showed a giant cystic mass in the retroperitoneal area.After injection of contrast agent,the mass showed heterogeneous enhancement.Surgery with local excision of the mass was performed to address the embedded abdominal blood vessels,and the histopathological and immunohistochemical diagnosis of the mass was GN.Postprandial vomiting was relieved,and no complications occurred after the operation.CONCLUSION In the diagnosis of giant retroperitoneal hypodense masses in children,GN should be considered if the mass presents delayed enhancement,punctate calcification,and vascular embedding but no invasion.Pathology is the golden standard for the diagnosis of GN,and surgical excision is the optimal treatment for GN.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 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 Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspe...BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.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
Fifty-two patients with chemotherapy comprise cisplatin, adriamycin and dacarbazine underwent antiemetic therapy form September 1994 to June 1995. The chemotherapy regimens include CAP-VDS, ACO, EP,CHOP, AMF and MFP. ...Fifty-two patients with chemotherapy comprise cisplatin, adriamycin and dacarbazine underwent antiemetic therapy form September 1994 to June 1995. The chemotherapy regimens include CAP-VDS, ACO, EP,CHOP, AMF and MFP. The dose of PDD was 60-70 mg/M2, ADR was 4050 mg/M2 and DTIC was 300 mg/M2.This study was the randomized, cross-over study, ruled out any differences between individual patients. Group A: Granisetron was given on the first day of chemotherapy, Granisetron 3 mg, Dexamethasone 10 mg i.v. at 30 minutes before chemotherapy, Group B:Ondansetron was given on the first and second days,Ondansetron 8 mg, Dexamethasone 10 mg i.v. at 30 minutes before chemo-therapy, The rates of complete control-free of vomiting were 80.8 % and 82.7% in both groups respectively at 24 hours(P>0.05), 57.7% and 53.9% respectively(M>0.05) at second day, and 67.3% and 53.9% respectively(P<0.05) at third day. No difference was observed between both groups for the result of antiemetic control in seven days, the rate of overall control are 82.7% and 80.8% respectively(P>0.05).Adverse events with both antiemetic treatments were mild(essentially headache), the percentage of headache with ondansetron was 9.5% and granisetron 7.7%, constipation with ondansetron was 80.8%and granisetron 61.5%.Constipation: Granisetron, given as one i.v. 3 mg injection before chemotherapy plus dexamethasone, and ondansetron, given intravenously 8 mg injection before chemotherapy at the first 2 days Plus dexamethasone are similar results on acute and dalayed chemotherapyinduced vomiting in patients receiving their intensely emetogenic regimen.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
Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A rand...Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed;Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia;and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-morphine spinal anesthesia.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family...<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>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
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
BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemo...BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.展开更多
Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 femal...Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.展开更多
文摘BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.
文摘Objective:To investigate the role of acupressure therapy in helping pregnant women with HG reduce the frequency or severity of vomiting and relieve stress and anxiety.Method:A quantitative study with a quasi-experimental design and non-equivalent group design was used.Sixty-six valid data points were obtained from pregnant mothers diagnosed with HG in a general hospital in Linyi City.These pregnant women received either acupressure(n=33)or general therapeutic care(n=33).They completed standardized questionnaires designed to assess vomiting,anxiety,and stress levels.Results:Data showed no differences between the experimental and control groups before the intervention.After the intervention,there were significant differences in anxiety(P≤0.05)and stress(P≤0.05)scores between the two groups.However,there was no significant difference in vomiting scores(P>0.05)between the two groups after the intervention.The anxiety and stress scores of the experimental group were significantly lower than those of the control group post-intervention,while the vomiting scores of the two groups were similar.Conclusion:The findings suggest that acupressure significantly reduces anxiety and stress in pregnant women with hyperemesis gravidarum(HG)and also helps reduce vomiting.Acupressure presents a viable clinical option for pregnant women seeking relief from HG symptoms.
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 emetogenie 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 eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties 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.
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.
文摘BACKGROUND Ganglioneuroma (GN) is a rare neurogenic tumor that accounts for about 0.1%- 0.5% of all tumors of the nervous system.It originates from neural crest cells.GN has no specific clinical symptoms or laboratory findings,which leaves it easily overlooked and misdiagnosed as other tumors.Retroperitoneal GN with very large volume and vascular penetration is extremely rare.CASE SUMMARY We present the imaging and pathological findings of a giant retroperitoneal GN in a child.A 4-year-old boy had suffered from postprandial vomiting for more than 6 mo with no precipitating factors.Abdominal computerized tomographic examination showed a giant cystic mass in the retroperitoneal area.After injection of contrast agent,the mass showed heterogeneous enhancement.Surgery with local excision of the mass was performed to address the embedded abdominal blood vessels,and the histopathological and immunohistochemical diagnosis of the mass was GN.Postprandial vomiting was relieved,and no complications occurred after the operation.CONCLUSION In the diagnosis of giant retroperitoneal hypodense masses in children,GN should be considered if the mass presents delayed enhancement,punctate calcification,and vascular embedding but no invasion.Pathology is the golden standard for the diagnosis of GN,and surgical excision is the optimal treatment for GN.
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.
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 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21004.
文摘BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.
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Fifty-two patients with chemotherapy comprise cisplatin, adriamycin and dacarbazine underwent antiemetic therapy form September 1994 to June 1995. The chemotherapy regimens include CAP-VDS, ACO, EP,CHOP, AMF and MFP. The dose of PDD was 60-70 mg/M2, ADR was 4050 mg/M2 and DTIC was 300 mg/M2.This study was the randomized, cross-over study, ruled out any differences between individual patients. Group A: Granisetron was given on the first day of chemotherapy, Granisetron 3 mg, Dexamethasone 10 mg i.v. at 30 minutes before chemotherapy, Group B:Ondansetron was given on the first and second days,Ondansetron 8 mg, Dexamethasone 10 mg i.v. at 30 minutes before chemo-therapy, The rates of complete control-free of vomiting were 80.8 % and 82.7% in both groups respectively at 24 hours(P>0.05), 57.7% and 53.9% respectively(M>0.05) at second day, and 67.3% and 53.9% respectively(P<0.05) at third day. No difference was observed between both groups for the result of antiemetic control in seven days, the rate of overall control are 82.7% and 80.8% respectively(P>0.05).Adverse events with both antiemetic treatments were mild(essentially headache), the percentage of headache with ondansetron was 9.5% and granisetron 7.7%, constipation with ondansetron was 80.8%and granisetron 61.5%.Constipation: Granisetron, given as one i.v. 3 mg injection before chemotherapy plus dexamethasone, and ondansetron, given intravenously 8 mg injection before chemotherapy at the first 2 days Plus dexamethasone are similar results on acute and dalayed chemotherapyinduced vomiting in patients receiving their intensely emetogenic regimen.
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Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed;Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia;and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-morphine spinal anesthesia.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>
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.
文摘BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.
文摘Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.
