Conventional Antiemetics Research Articles

The Role os Acupunture in the Mannagement os Nausea and Vomiting After Chemotherapy

Introduction: Acupuncture is a technique of Traditional Chinese Medicine in which needling stimulates body points, promoting therapeutic effects and energetic balance of organs and viscera. Disruption of the natural flow of stomach descent force and rising Qi can cause nausea and vomiting (N/V), the main side effects of chemotherapy, related to reduced adherence and prolonged treatment. Objective: To conduct a literature review on the role of acupuncture in the management of nausea and vomiting after chemotherapy. Methodology: Articles (randomized blinded clinical trials, systematic reviews with meta-analysis, integrative literature reviews, therapeutic manuals, epidemiological databases) were searched on PubMed between 2012 and 2022. Exclusion criteria were outdated articles and/or those focused on a specific patient profile or neoplastic pathology. Result and discussion: In case of high- risk therapies, nausea and vomiting are hardly treatable with conventional antiemetics. When acupuncture was compared to ondansetron, there was a more significant response in the acupuncture group (52.8%) than in the ondansetron group (35.7%). There was a significant decrease in the frequency of N/V between the first and second chemotherapy cycles (P < 0.0358) and in their intensity (P < 0.0087) between the control group and patients who received transcutaneous electrical nerve stimulation (TENS) therapy at acupuncture point PC6. Conclusion: Acupuncture can be used as an alternative and complementary treatment, especially for patients who do not tolerate the side effects of conventional antiemetics. However, the literature is still controversial due to the small number of available studies and/or small sample

Efficacy of Xiang-Sha-Liu-Jun-Zi on chemotherapy-induced nausea and vomiting: A protocol for systematic review and meta-analysis.

Background:Cancer is the main cause of death worldwide, and chemotherapy is the basic method of treating cancer. However, chemotherapy-induced nausea and vomiting (CINV) is the most common side effect of chemotherapy, and conventional antiemetics for the treatment of CINV also have side effects. At present, a large number of randomized controlled trials have shown that Xiang-Sha-Liu-Jun-Zi (XSLJZ) can effectively treat CINV, but there is no systematic review. Therefore, this systematic review aims to discuss the effectiveness of XSLJZ in the treatment of CINV.Methods:Search for relevant documents in the Chinese and English databases, and the search time is limited to March 2021. Databases include Embase, Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure, Chongqing VIP Information Resource Integration Service Platform, Wanfang Data, Chinese Biomedical Literature, etc. We will search the international clinical trial registration platform and the Chinese clinical trial registration platform to find ongoing and unpublished clinical trials. Randomized controlled trial of the efficacy of XSLJZ in the treatment of CINV were collected. After screening the literature according to the inclusion and exclusion criteria, two researchers independently extracted the data. The effective rate of treatment is the main outcome indicator of this study. The secondary indicators of this study include the incidence of adverse reactions and the improvement rate of quality of life. RevMan 5.3.5 software was used for statistical analysis. Grades of Recommendation, Assessment, Development, and Evaluation system will be used to evaluate the quality evidence for each outcome.Results:This study will provide the latest evidence for the treatment of CINV by XSLJZ.Conclusion: To evaluate the efficacy of XSLJZ in the treatment of CINV.Unique INPLASY number:INPLASY202140079.

The Effectiveness of Common Cannabis Products for Treatment of Nausea.

We measure for the first time how a wide range of cannabis products affect nausea intensity in actual time. Even though the Cannabis plant has been used to treat nausea for millennia, few studies have measured real-time effects of common and commercially available cannabis-based products. Using the Releaf App, 886 people completed 2220 cannabis self-administration sessions intended to treat nausea between June 6, 2016 and July 8, 2019. They recorded the characteristics of self-administered cannabis products and baseline symptom intensity levels before tracking real-time changes in the intensity of their nausea. By 1 hour postconsumption, 96.4% of people had experienced symptom relief with an average symptom intensity reduction of -3.85 points on a 0 to 10 visual analog scale (SD=2.45, d=1.85, P<0.001). Symptom relief was statistically significant at 5 minutes and increased with time. Among product characteristics, flower and concentrates yielded the strongest, yet similar results; products labeled as Cannabis indica underperformed those labeled as Cannabis sativa or hybrid; and joints were associated with greater symptom relief than pipes or vaporizers. In sessions using flower, higher tetrahydrocannbinol and lower cannabidiol were generally associated with greater symptom relief (eg, within 5 min). The findings suggest that the vast majority of patients self-selecting into cannabis use for treatment of nausea likely experience relief within a relative short duration of time, but the level of antiemetic effect varies with the characteristics of the cannabis products consumed in vivo. Future research should focus on longer term symptom relief, including nausea-free intervals and dosing frequency; the risks of consumption of medical cannabis, especially among high-risk populations, such as pregnant women and children; and potential interactions between cannabis, conventional antiemetics, other medications, food, tobacco, alcohol, and street drugs among specific patient populations.

Cannabinoid Hyperemesis Syndrome: A Review of the Presentation and Treatment

After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a syndrome of cyclic vomiting related to chronic cannabis use. The difficulty of diagnosis and treatment of this syndrome has led to a disproportionately high use of health care resources. Although the exact mechanism of cannabinoid hyperemesis syndrome is still unknown, patients typically progress through prodromal, hyperemetic, and recovery phases. Persistent vomiting in a patient who reports relief with hot showers should trigger the consideration of cannabinoid hyperemesis syndrome as a possible diagnosis. For treatment, antipsychotics such as haloperidol or droperidol have been shown to be more effective than conventional antiemetics for symptom control. Capsaicin should also be considered, given its positive efficacy and low adverse-effect profile. Providers must be aware of cannabinoid hyperemesis syndrome, its diagnosis, and treatment, given the increasing prevalence. Further research is required to elicit the exact mechanism and additional therapies for this syndrome.

Implementation of isopropyl alcohol (IPA) inhalation as the first-line treatment for nausea in the emergency department: practical advantages and influence on the quality of care

BackgroundNasal inhalation of isopropyl alcohol (IPA) seems an effective anti-emetic for the symptomatic treatment of nausea in the emergency department (ED) compared to conventional anti-emetics (Ondansetron and Metoclopramide). However, it is not yet known what the practical consequences are related to the use of IPA in the ED.ObjectivesThe purpose of this study was to assess the practical implications for patient care associated with IPA use and to evaluate the viability of permanent implementation of IPA inhalation as a first-line therapy for nausea in the ED.MethodsWe conducted a prospective, single-center implementation study comparing ED-based care for nauseated patients before (n=106) and after (n=104) the introduction of IPA. We evaluated the treatment process and cost and assessed implementation using a survey based on recommended implementation outcome measures.ResultsComparing baseline phase to implementation phase, we found a significant increase in the percentage of patients receiving nausea treatment (66.0% versus 97.1%; p<0.001) and a reduction in time to treatment initiation (7 versus 1 min, p<0.001). Additionally, IPA introduction was associated with a decrease in the administration of conventional anti-emetics (0.52 versus 0.23 administrations per patient, p<0.001) and a notable drop in treatment cost (€1.33 versus €0.67 per patient). Nurses were content with IPA implementation and regarded definitive implementation as feasible and sustainable.ConclusionImplementation of IPA as the first-line nausea treatment in the ED can increase the quality of care and improve care efficiency. Definitive implementation of IPA as a first-line treatment in the ED is both viable and practically feasible.Trial registrationNTR, NL7717, Registered on March 23, 2018 - Retrospectively registered

Pharmacotherapeutic Considerations for Use of Cannabinoids to Relieve Symptoms of Nausea and Vomiting Induced by Chemotherapy.

Patients suffering from malignant diseases receive very often highly emetogenic chemotherapy as part of their treatment.With the aim of assessing the efficacy of cannabinoids in treating chemotherapy-induced nausea and vomiting (CINV), we searched the literature published until April 2020 in Medline/PubMed, Embase, the Cochrane Controlled Trials Register, and in specific web pages. Randomized clinical trials comparing cannabinoids efficacy in managing CINV with that of placebo reported absence of vomit-ing (3 trials, 168 patients) and absence of nausea and vomiting (3 trials, 288 participants). In comparison with patients receiving other antiemetics, patients receiving cannabinoids reported no nausea (5 trials, 258 participants), no vomiting (4 trials, 209 participants), and absence of both (4 trials, 414 patients). Across all trials, cannabinoids were more effective in relieving the symptoms of nausea and vomiting induced by cytotoxic therapy than placebo was and slightly better than conventional antiemetics. A retrospective review com-paring nabilone, dronabinol, delta-9-THC, and delta 8-THC with other antiemetics used to manage CINV in pediatric patients showed that these drugs could also be used as adjuvant antiemetics. Cancer patients on highly emetogenic chemotherapy but with insufficiently effective standard antiemetic therapy can be given cannabis preparations containing similar amounts of tetrahydrocannabinol and can-nabidiol, which should be received in strict compliance with the professional guidelines for the treatment of CINV.

Should Olanzapine be Advocated Over Conventional Anti-Emetics for the Prevention of Chemotherapy-Induced Nausea and Vomiting? An Updated Meta-Analysis of Randomized Control Trials

Objective: The aim of this study is to synthesize the evidence about the efficacy of Olanzapine for the prevention of CINV. Methods: A computer literature search of PubMed, EBSCO, Ovid, and Cochrane CENTRAL databases has been conducted. Studies were screened for eligibility and data were extracted. The proportion of patients with complete response (CR) and those with no nausea were pooled as risk ratio (RR) in a fixed effect model meta-analysis using Review Manager Version 5.3 for windows. Results: Nine randomized controlled trials (n=1572) were pooled in the final analysis. In all studies, olanzapine was given as 10 mg PO. Olanzapine was superior to active control in terms of CR rate in acute phase (RR 1.12, 95% CI [1.02, 1.22], p=0.01]), delayed phase (RR 1.31, 95% CI [[1.10, 1.56], p=0.002), and overall phase (RR 1.30, 95% CI [1.09, 1.55], p=0.004). Rates of no nausea were significantly higher in olanzapine 10 mg group compared to active control group in acute phase (RR 1.20, 95% CI [1.04, 1.38], p=0.01), delayed phase (RR 1.72, 95% CI [1.42, 2.08], p&lt;0.00001), and overall phase (RR 1.57, 95% CI [1.39, 1.77], p &lt;0.00001). The incidence of adverse events was similar in olanzapine and control groups, with the most frequently reported treatment-related emergent adverse events being fatigue, constipation, and headache. Conclusion: Olanzapine is a well-tolerated drug for cancer patients and has shown superiority against conventional antiemetics for the prevention of CINV.

Cannabinoid Hyperemesis Syndrome in Pregnancy: A Case Report and Treatment Overview

Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical vomiting, frequent hot water bathing, and chronic cannabis use. Missed diagnosis, especially in pregnancy, may delay treatment and prolong extensive medical assessments. Conventional antiemetics used to control vomiting illnesses are typically ineffective in CHS and pharmacological treatment may be limited due to concern for harm to the fetus during pregnancy. This case report describes a 19-year-old African American female at twenty weeks gestation with CHS. Successful symptom relief was obtained with diphenhydramine, haloperidol, and dronabinol. A literature search identified five case reports regarding cannabinoid hyperemesis syndrome in pregnancy. This case report highlights the importance of recognizing common characteristics of CHS especially in pregnant women with a history of cannabis use. Additionally, the purpose of this article is to review the current literature available for the treatment of CHS and expand recognition of CHS as an increasingly prevalent condition.

Clinical Pharmacology Research for Promoting Individualized Cancer Chemotherapy

Cancer chemotherapy has progressed remarkably with conventional and molecular-targeted anticancer drugs as well as immune checkpoint inhibitors. However, adverse drug reaction (ADR) management remains a challenge in cancer chemotherapy. Therefore, improving the quality of medical care through clinical pharmacology research is warranted. Intravenous injection of bendamustine in patients with follicular or mantle cell lymphoma frequently causes venous irritation. Because the underlying mechanisms are not clear, we investigated the factors responsible for bendamustine-induced venous irritation. Based on the results of our analysis, we altered the administration regimen and observed that the incidence of venous irritation, which manifested in a concentration-dependent manner following conventional approaches, significantly decreased when following the modified regimen. Guidelines on the management of chemotherapy-induced nausea and vomiting recommend aprepitant, a selective neurokinin-1 (NK-1) receptor antagonist, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, and dexamethasone as prophylactic antiemetics. Pretreatment with high-dose chemotherapy before hematopoietic stem cell transplantation has extremely high emetogenic potential. This can be countered by using aprepitant in combination with conventional antiemetics. However, the safety and efficacy of such combinations are unexplored. Upon evaluation, we observed improved antiemetic effects without an increase in ADRs. At this symposium, I highlight the significance of clinical pharmacology research for promoting individualized cancer chemotherapy.

Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline.

IntroductionCannabinoid hyperemesis syndrome (CHS) is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED) repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety.MethodsThe San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS.ResultsPer the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief.ConclusionAn expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS patients with strategies that decrease exposure to opioids, minimize use of healthcare resources, and maximize patient safety.

A single-dose comparative bioavailability study of dronabinol oral solution versus dronabinol capsules in healthy volunteers.

198 Background: The capsule formulation of dronabinol, a pharmaceutical tetrahydrocannabinol (THC), is approved for anorexia associated with weight loss in patients with AIDS and for cancer chemotherapy-associated nausea/vomiting in patients with inadequate response to conventional antiemetics. A new oral formulation (i.e., dronabinol solution) was evaluated in a bioequivalence study versus currently marketed dronabinol capsules. Methods: In an open-label, 2-treatment, 2-sequence, 4-period, single-dose crossover study, healthy volunteers were randomized to receive 1 of 2 treatment sequences (T-R-T-R or R-T-R-T; T = dronabinol 4.25 mg oral solution and R = dronabinol 5 mg capsules). Dosing occurred after an overnight fast, with a minimum 7-day washout period between treatment periods. A validated liquid chromatography-tandem mass spectrometry method was used to determine plasma concentrations of dronabinol and the primary metabolite 11-OH-Δ9-THC. Results: Fifty-one of 52 enrollees had pharmacokinetic data for analysis. Mean pharmacokinetics were (oral solution vs capsule): Cmax (2.0 vs 2.4 ng/mL), median Tmax (1.0 vs 1.5 h), AUC0-∞ (3.8 vs 4.1 h∙ng/mL), and t1/2 (5.6 vs 3.1 h). The 2 formulations were bioequivalent with respect to maximum plasma concentration (Cmax; reference-scaled criteria) and area under the plasma concentration-time curve (from time zero to last measurable concentration and from time zero to infinity [AUC0-∞]; average bioequivalence) of dronabinol. The data for the 11-OH-Δ9-THC metabolite provide further support for the bioequivalence of the 2 products. Post hoc analysis demonstrated that all volunteers (100%) had detectable plasma dronabinol concentrations at 15 min with the oral solution compared with &lt; 25% of volunteers for the capsules. Intra-individual variability was lower with oral solution versus capsules (for AUC0-∞, 13.5% vs 36.8%, respectively). Conclusions: Dronabinol oral solution 4.25 mg was bioequivalent to dronabinol capsules 5 mg, and exhibited quicker onset of detectable levels and lower intra-individual variability in comparison with dronabinol capsules 5 mg. Clinical trial information: NCT01448772.

Integrative Medicine for Relief of Nausea and Vomiting in the Treatment of Colorectal Cancer Using Oxaliplatin-Based Chemotherapy: A Systematic Review and Meta-Analysis.

The management of chemotherapy-induced nausea and vomiting (CINV) remains an issue in the treatment of colorectal cancer using oxaliplatin-based regimens. Certain traditional plant-based medicines (TMs) have histories of use for nausea and vomiting and have been integrated with conventional therapies for CINV. To assess the effectiveness of integrative management of CINV, meta-analysis was conducted of 27 randomised controlled studies (1843 participants) published from 2005 to 2013. The oxaliplatin plus TM groups showed significantly reduced CINV (risk ratio 0.65 [0.59, 0.71], I(2) = 28%) compared with oxaliplatin controls, with or without the addition of conventional anti-emetics. Further sensitivity analyses based on the ingredients of the TMs identified six plants (Atractylodes macrocephala, Poria cocos, Coix lacryma-jobi, Astragalus membranaceus, Glycyrrhiza uralensis and Panax ginseng) that were associated with significant reductions in CINV without important heterogeneity. Experimental studies of these six plants have reported inhibitory effects on nausea and vomiting (or its animal equivalent), regulation of gastrointestinal motility, gastroprotective effects and antioxidant actions, which may at least partially explain the effects identified in the meta-analyses of the clinical trial results. These plants warrant further clinical research as potential additions to chemotherapy regimens in patients whose CINV is not sufficiently well controlled by conventional therapies. Copyright © 2016 John Wiley & Sons, Ltd.

Efficacy, tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting--a systematic review of systematic reviews.

There is growing public and legislative body support for the medical use of cannabis products, for example, for chemotherapy-induced nausea and vomiting (CINV), in Germany. A comprehensive literature search until November 2015 was conducted in MEDLINE, DARE and Cochrane libraries for systematic reviews of randomized controlled trials (RCTs) comparing herbal or pharmaceutical cannabinoids (CB) versus placebo or conventional antiemetics for CINV. Outcomes were reduction of CINV for efficacy, drop-out rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the systematic reviews was evaluated by the tool assessment of multiple systematic reviews (AMSTAR). Six systematic reviews of RCTs included the pharmaceutical CBs dronabinol, levonantradol, and nabilone or whole plant extract (e.g., nabiximol) compared with placebo or conventional antiemetics. There was moderate quality evidence on the efficacy of CBs compared to placebo and conventional antiemetics for CINV. There was moderate quality evidence that pharmaceutical CBs were less tolerated and less safe than placebo and conventional antiemetics in CINV. One RCT examining whole plant extract was included into the systematic reviews. No RCT was found comparing CBs with neurokinine-1 receptor antagonists. With safe and effective antiemetics available, CBs cannot be recommended as first- or second-line therapy for CINV. Some guidelines recommend pharmaceutical CBs as third-line treatment in the management of breakthrough nausea and vomiting. Due to the lack of RCT data and safety concerns, herbal cannabis cannot be recommended for CINV.

Development of Zindol® through multi-center clinical trial for chemotherapy induced nausea and vomiting

Despite the widespread use of 5-HT3 receptor antagonist anti-emetics, chemotherapy induced nausea and vomiting (CINV) continues to be reported by up to 70% of adult patients and up to 58% of children receiving highly emetogenic chemotherapy agents. Nausea and vomiting are among the most distressing side effects of chemotherapy. Zindol® is an enhanced ginger product that is standardized by the bioactive constituents, gingerols and shogaols, of ginger (Zingiber officinale Roscoe). We utilized polarity-guided supercritical fluid fractionation SFS-CXF technology to establish conditions for the isolation of the active ingredients and then manufactured the API using SFS-CXP following cGMP. The API was then formulated to achieve a specific concentration of gingerols and shogaols with all-natural liquid excipients designed to maximize the stability and bioavailability of the bioactive constituents and encapsulated into gel capsules with a nitrogen head following cGMP. Zindol® was successfully evaluated in a multi-center, 644-patient, dose-finding, placebo-controlled, randomized Phase II/III clinical trial as an adjunctive therapy to conventional 5-HT3 anti-emetics for nausea in cancer patients undergoing chemotherapy (US Patent). We have since studied the MOA using a newly developed in vitro potency assay (US Patent Pending) and are planning to conduct a pivotal Phase III clinical trial for CINV and file an NDA with the FDA. A sister dietary supplement product, Zindol® DS, has been reported to be safe and effective in motion sickness, and nausea and vomiting related to pregnancy, elective surgery and medications. We plan to conduct rigorous clinical trials for these indications after NDA approval of Zindol® for CINV in adult and pediatric populations.

Acupuncture in 21st Century Anesthesia

Acupuncture in 21st Century Anesthesia

Haloperidol for treatment of cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome (CHS) is a condition characterized by cyclical vomiting without other identifiable cause in patients with chronic cannabis use. Patients with CHS report that compulsive bathing and hot showers are the only reliable treatments to improve symptoms. Cannabinoid hyperemesis syndrome is usually unresponsive to conventional pharmacologic antiemetics, and patients often require hospital admission. We report a case of CHS that improved significantly after treatment with haloperidol in the emergency department.

Comparative evaluation of ondansetron and granisetron in prevention of postoperative nausea and vomiting following laparoscopic cholecystectomy in females

Post operative nausea and vomiting (PONV) continue to be frequent occurrences, even when conventional antiemetics are prophylactically used. In a randomized double blind study, 100 female patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were divided into 2 groups of 50 patients each and received 0.1mg/Kg of Ondansetron (Group X) or 0.04mg/Kg of Granisetron (Group Y) pre- operatively. Patients were observed for 24 hours post operatively and interpretation of symptoms of nausea and vomiting was done according to Gan and Alexander scale (0-2). 80% of patients in Group Y and 48 % patients in Group X did not experience PONV; the difference was statistically significant (p<0.001). 2 patients (4%) in Group Y and 15patients (30%) in Group X required rescue antiemetic medication during the 24 hour study period. The difference was found to be highly significant (p<0.001) The difference in the incidence of PONV between the two groups after 6 hours to 24 hours was highly significant (p<0.001). It was concluded that prophylactic administration of Granisetron is more effective than Ondansetron, in reducing in incidence of PONV with prolonged effects.

Evaluation of the efficacy of Granisetron over Droperidol in the prevention of Postoperative Nausea and Vomiting following open Cholecystectomy

BACKGROUND: Post operative nausea and vomiting (PONV) continue to be frequent occurrences, even when conventional antiemetics are prophylactically used.&#x0D; OBJECTIVE: To compare the efficacy of Granisetron over Droperidol in the prevention of PONV in patients undergoing elective open cholecystectomy under general anesthesia.&#x0D; MATERIAL &amp; METHODS: In this double blind randomized study, 100 adult patients with physical status ASA I and II, (age, 20-60 years), were randomly allocated into two groups, X or Y, to receive either injection Granisetron hydrochloride (3 mg i/v) or Droperidol (2.5 mg i/v), 5 min prior to induction of general anesthesia. The incidence of nausea and vomiting was recorded every six hourly for a period of 24 hour after the surgery.&#x0D; RESULTS: 6 (12%) patients in the granisetron group and 20 (40%) patients in the Droperidol group reported an emetic episode, (p = 0.002); the incidence of PONV in the total 24 hr period after the surgery, 54% in the granisetron group and 76% in Droperidol group (p = 0.022)&#x0D; CONCLUSIONS: It was found that granisetron is superior to Droperidol in the prevention of postoperative nausea and vomiting. JMS 2011;14(1):11-14

RETRACTED: Comparison of propofol, droperidol, and metoclopramide for prophylaxis of postoperative nausea and vomiting after breast cancer surgery: A prospective, randomized, double-blind, placebo-controlled study in Japanese patients

Breast cancer surgery performed with the patient under general anesthesia has been associated with a relatively high incidence of postoperative nausea and vomiting (PONV). Between 60% and 80% of patients who undergo mastectomy (with axillary dissection) experience PONV. We previously reported that propofol at a subhypnotic dose of 0.5 mg/kg was more effective than placebo in preventing PONV in women who undergo mastectomy. The purpose of this study was to compare the efficacy of a subhypnotic dose of propofol with the conventional antiemetics droperidol and metoclopramide for the prophylaxis of PONV after breast cancer surgery in Japanese patients. In this prospective, randomized, double-blind, placebo-controlled study, Japanese women were randomized to 1 of 4 groups to receive IV administration of propofol 0.5 mg/kg, droperidol 20 microg/kg, metoclopramide 0.2 mg/kg, or placebo (isotonic saline) immediately after skin suture. A standard general anesthetic technique, including sevoflurane and air in oxygen, was used. All episodes of PONV during the first 24 hours after anesthesia administration were recorded by an investigator who was blinded to treatment assignment. The investigator questioned the patients as to whether they experienced extrapyramidal symptoms. To maintain the integrity of the study results, none of the patients received preanesthetic medication. A total of 100 women (mean [SD] age, 52 [7] years; height, 154 [6] cm; weight, 54 [7] kg) were included in the study. Each study group comprised 25 patients. There were no significant differences between treatment groups with regard to patient demographics, surgery type, or awakening time. The prevalences of PONV 0 to 24 hours after anesthesia were 28% with propofol (P = 0.005), 32% with droperidol (P = 0.011), and 60% with metoclopramide (P = NS), compared with placebo (68%). No significant difference in the prevalence of PONV was found between patients receiving propofol and those receiving droperidol, and propofol and droperidol were associated with significantly lower prevalences of PONV compared with metoclopramide (P = 0.022 and P = 0.043, respectively). Extrapyramidal symptoms were not reported in any of the groups. The prevalences of PONV were not significantly different between propofol 0.5 mg/kg and droperidol 20 microg/kg 0 to 24 hours after anesthesia in this small, select group of Japanese women who underwent breast cancer surgery. The prevalences of PONV were significantly lower with propofol and droperidol compared with metoclopramide 0.2 mg/kg and placebo.

Improved antiemetic treatment with levomepromazine (author's transl)

The antiemetic effect of levomepromazine (Neurocil) was tested in 76 patients treated for metastasizing malignancies with cis-dichlorodiammineplatinum (II) (Platinex). In all patients conventional antiemetics had been ineffective against gastrointestinal side effects of platinum. Using levomepromazine vomiting and nausea could be successfully prevented in 47 out of 63 patients on conventional cis-platinum doses (20 mg/m2 for 5 consecutive days) and in 5 out of 13 patients on high single day dosages (100 mg/m2). In most other patients clear-cut subjective improvement occurred. The antiemetic effect of levomepromazine against cis-platinum, which ranks among the most widely used cytostatics and causes gastrointestinal symptoms, is of importance in medico-oncological practice as it causes relief for the patients.