Effect Of Transdermal Scopolamine Research Articles

Effect of Transdermal Scopolamine for the Prevention of Postoperative Nausea and Vomiting Associated With Robotic Gynecologic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Abstract Objective: To evaluate the efficacy of transdermal scopolamine for treatment of postoperative nausea and vomiting (PONV) after robotic-assisted gynecologic surgery. Design: Prospective, randomized, double-blinded, placebo-controlled clinical trial. Method: Overall, 47 patients underwent robotic-assisted gynecologic surgery at two tertiary care hospitals, and they were randomized to receive transdermal scopolamine or placebo preoperatively. They then completed a series of questionnaires utilizing a visual analogue scale to rate their nausea and vomiting. Main outcomes were severity of nausea and vomiting till 72 hours postoperatively. Secondary outcomes were antiemetic use, time to discharge, effect on patient well-being of PONV, and patient overall well-being. Results: There was a benefit to the number of rescue antiemetics administered in the immediate postoperative period (0.30 vs. 0.70, p=0.026), but no significant reduction in incidence or severity of PONV, no overall decrease in amount of an...

The effect of transdermal scopolamine in addition with intravenous dexamethasone for prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery

The effect of transdermal scopolamine in addition with intravenous dexamethasone for prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery

The effect of transdermal scopolamine plus intravenous dexamethasone for the prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery

BackgroundPostoperative nausea and vomiting (PONV) is common complication of Patient-Controlled Analgesia (PCA) after surgery. The authors sought to determine whether a transdermal scopolamine (TDS) patch in combination with IV dexamethasone is more effective than IV dexamethasone alone or IV dexamethasone plus IV ramosetron for reducing PONV in patients receiving epidural PCA after major orthopedic surgery.Methods120 patients that received epidural PCA with hydromorphone and ropivacaine after major orthopedic surgery under spinal anesthesia were allocated to 3 groups: Group D (n = 40) received IV dexamethasone 8 mg, Group DR (n = 40) received IV dexamethasone 8 mg plus IV ramosetron 0.3 mg, Group DS (n = 40) received IV dexamethasone 8 mg plus a TDS patch (Group DS, n = 40). Nausea and vomiting incidences, VAS for nausea, the use of additional antiemetics, and adverse effects (a dry mouth, blurred vision, drowsiness) during the first 24 hours postoperatively were subjected to analysis.ResultsThe DS Group had a significantly higher rate of complete remission of PONV than the D and DR groups (82.5% vs 47.5%, and 50.0%, respectively), and had lower rates of nausea (17.5% vs 55.0%, and 50.0%), and vomiting (10.0% vs 50.0%, and 25.0%), and required less antiemetics (5.0% vs 35.0%, 22.5%) than group D and Group DR during the first 24 hours after surgery. Furthermore, no inter-group differences were observed with respect to adverse effects in the three groups.ConclusionsThe prophylactic use of a TDS patch plus dexamethasone was found to be a more effective means of preventing PONV in patients that received epidural PCA after major orthopedic surgery than dexamethasone alone or dexamethasone plus ramosetron without adversely affecting side effects.

Effect of transdermal scopolamine on heart rate variability in patients with severe coronary heart disease.

A decrease in cardiac parasympathetic tone is a recognized finding in patients with ischemic heart disease, correlating closely with disease severity and overall survival. The aim of this study was to assess whether transdermal scopolamine (Tds), which increases parasympathetic tone in healthy volunteers, increases vagal tone in patients with severe CAD and whether it might have an antiischemic effect. Fifteen patients (10 men, aged 55 +/- 8 years) with three-vessel CAD, but with no prior MI and preserved ventricular function, underwent 24-hour Holter monitoring and exercise testing before and after wearing a scopolamine patch for 24 hours. Time-domain measures of heart rate variability (HRV) and the total number and duration of ischemic episodes were obtained from the Holter recordings for each patient. Tds significantly (P < 0.05) increased the values of all HRV measures. Tds also reduced the total number of ischemic episodes (from 273 to 159, P < 0.05) and their total duration (from 136 to 46 min per patient, P < 0.05). Tds also increased treadmill exercise duration from 293 +/- 101 to 345 +/- 95 seconds (P < 0.05) and the time to 1-mm ST depression from 177 +/- 105 to 244 +/- 128 seconds (P < 0.02), while maximum ST depression was reduced from 2.86 +/- 0.6 to 2.3 +/- 0.3 (P < 0.05). No significant side effects were observed. Tds modifies the autonomic balance in patients with severe CAD toward a condition associated with a better prognosis. It may also be useful as an adjunctive treatment for ischemic heart disease.

Effects of low dose transdermal scopolamine on heart rate variability in acute myocardial infarction

Objectives. We hypothesized that by enhancing parasympathetic activity, low dose transdermal scopolamine would increase heart rate variability after myocardial infarction.Background. Low heart rate variability is associated with increased mortality after acute myocardial infarction.Methods. Conventional time domain heart rate variability was measured from 24-h Holter recordings of 61 consecutive male patients (mean age 58 ± 10 years, left ventricular ejection fraction 44.7 ± 15,5%) 6 days (median) after acute myocardial infarction. Patients were then randomly assigned to wear one patch of transdermal scopolamine or a matching placebo patch for 24 h, during which their 24-h heart rate variability was remeasured.Results. Compared with placebo, transdermal scopolamine caused a significant increase in time domain measures of 24-h heart rate variability by 26% to 35% above baseline. Transdermal scopolamine was well tolerated.Conclusions. Low dose transdermal scopolamine safely increases cardiac parasympthetic activity and short-term heart rate variability after acute myocardial infarction. Whether the effect of transdermal scopolamine on heart rate variability is a reasonable surrogate for improvement of long-term morbidity and mortality requires an appropriately designed investigation.

Effects of transdermal scopolamine on heart rate variability in normal subjects

A decrease in cardiac parasympathetic tone is a recognized finding in patients with ischemic heart disease, sudden cardiac death and heart failure, correlating closely with disease severity and overall survival. To study the clinical potential of vagomimetic intervention, the effect of transdermal scopolamine on fluctuations in heart rate was studied in 32 healthy adult subjects using both time-domain (mean RR interval, standard deviation of the mean RR interval, mean of the differences between consecutive RR intervals) and frequency-domain measures (spectrum analysis of 128 consecutive RR intervals) of heart rate variability. After an exposure of 24 hours, transdermal scopolamine resulted in a significant increase in all indexes tested. The increase was most pronounced in the 0.25-Hz respiratory peak of the RR interval power spectrum, compatible with a strong vagomimetic mode of action of transdermal scopolamine. Results indicate that transdermal scopolamine may have potential merit as a selective vagotonic agent in certain patients with myocardial infarction, heart failure or ventricular arrhythmias.

Effect of Transdermal Scopolamine on Induced Nystagmus

Transdermal scopolamine (TTS-scopolamine) in the acute attack phase of Meniere's disease has been proved in our previous reports to be effective in alleviating vertigo and nausea. The effect of TTS-scopolamine on evoked nystagmus was evaluated in this study.Ten healthy adult volunteers, five male and five female, with a mean age 28.2 were examined. First, the following tests were performed : optokinetic nystagmus, rotatory induced nystagmus and caloric nystagmus. Optokinetic stimuli were given in 4°/sec2 in 30sec acceleration and deceleration each, without a pause. Rotatory induced nystagmus was provoked with acceleration and deceleration, first 60°/sec rotation in 0.5sec and deceleration in 30sec to standstill without a pause. Caloric stimulation was irrigation with 20°C for 20sec. Nystagmus was analyzed by counting the total number of beats, slow phase velocity and duration.After the application of two sheets of TTS-scopolamine over the mastoids the above procedures were repeated.TTS-scopolamine had no significant effect on any form of nystagmus, although the vertiginous sensation and nausea elicited with caloric stimmuli were decreased in most subjects. Although the present results did not clearly demonstrate an inhibitory effect on vestibular nuclei, TTS-scopolamine might partially block the pathway from the vestibular system to the central autonomic center.