Nausea And Vomiting Research Articles

Anaemia prevention among pregnant women: Views and experiences of pregnant women and antenatal care providers in Accra, Ghana

Background and ObjectiveAnaemia among pregnant women is a public health challenge in Ghana. Although there isa national programme of routine iron-folic acid (IFA) supplementation, coverage issuboptimal. The current study explored experiences and perceptions of anaemiaprevention, and IFA use among pregnant women and antenatal care providers at twohospitals in Accra, Ghana, for enhancing the supplementation programme.MethodsUtilizing a qualitative approach, 6 focus group discussions with 48 purposively selectedpregnant women, and 10 in-depth interviews with care providers in two hospitals wereconducted. Interviews were transcribed verbatim. Using both deductive and inductiveapproaches, priori themes that informed the design of the interview guides, and emergingcodes from transcripts were used in data analysis.ResultsIn both hospitals, pregnant women reported awareness of anaemia and identified poorquality diets and failure to take IFA as the predominant causes. Regular IFAsupplementation, and consumption of fruits, vegetables, and animal-source foods wereindicated as the main anaemia remedies by the pregnant women. Turkey berry, beetroot,and hibiscus flower were also reported as therapeutic remedies for anaemia. IFA use waslinked with improved appetite, haemoglobin, and health status of mothers and their fetus.Both providers and pregnant women indicated that IFA is freely accessible throughgovernment facilities but may also be purchased. IFA supplements are recommended to betaken daily but three times for treatment; however, non-adherence to the recommendedfrequency was reported. This was attributed to adverse reactions including nausea andvomiting, unanticipated cost of increased appetite, forgetfulness to take IFA,misperceptions about adverse effects of IFA, transportation cost to access IFA, and longwaiting time at hospitals. Community-level focused antenatal care, follow-up visits, andphone calls were reported by providers as strategies to improve IFA uptake. Communitysensitization, enhanced access to IFA, and participatory approach to ANC services weresuggested by pregnant women as strategies for improving IFA uptake.ConclusionsFood insecurity and misperceptions about IFA should be addressed as part of efforts toaddress low IFA adherence and high maternal and child anaemia rates in Ghana.

Which 5-HT3 antagonist prevents nausea and vomiting in cesarean section more effectively: a network meta-analysis.

Selective 5-hydroxytryptamine 3 receptor (5-HT3) antagonists are commonly used to prevent nausea and vomiting (NV) after cesarean section, but the comparative efficacy of different 5-HT3 antagonists remains unclear. This network meta-analysis aimed to determine which 5-HT3 antagonists might be the preferred choice for preventing NV in parturient scheduled for elective cesarean delivery under spinal anesthesia. PubMed, EMBASE, Cochrane library, and Web of Science were searched for relevant randomized controlled trials (RCTs) published before August 24, 2023. Random network meta-analysis was performed using Stata 14.0 to estimate the efficacy of different 5-HT3 antagonists in preventing intra- and post-operative NV. Twenty-eight studies involving seven dosing regimens of three 5-HT3 antagonists were included. Pooled results showed that ondansetron 12 mg was superior to other six dosing regimens in the prevention of postoperative NV (PONV), PON, and POV, with the ranking probability of 80.2%, 95.8%, and 87.7%, respectively, followed by granisetron two mg. Ondansetron 4 mg might be the first choice for preventing intraoperative NV (IONV) (92.8%), with the least use of postoperative rescue antiemetics (90.6%). Granisetron 3 mg and tropisetron 2 mg might be the best options for preventing ION and IOV, respectively. Based on available data, ondansetron 12 mg may have the best efficacy in preventing PONV, PON, and POV. Additionally, more studies are warranted to compare the safety of ondansetron 12 mg versus granisetron two mg.

Oral 5-aminolevulinic acid administration before transurethral resection of bladder tumor induces perioperative nausea and vomiting

BackgroundThe efficacy of photodynamic diagnosis using 5-aminolevulinic acid during transurethral resection of bladder tumors has been demonstrated, albeit with limited information regarding its side effects. This study aimed to clarify the impact of oral 5-aminolevulinic acid on perioperative nausea and vomiting (NV) for the first time in a real-world clinical practice setting. MethodsPatients who underwent transurethral surgery at Kagawa University between April 2017 and March 2020 were included. Perioperative NV and antiemetic use status were prospectively assessed and compared between the patients who received oral 5-aminolevulinic acid and those who did not. Additionally, univariate and multivariate analyses were performed for predicting postoperative nausea and vomiting. ResultsOf 214 patients, 74 (34.6%) received oral 5-aminolevulinic acid preoperatively. The proportions of preoperative NV and antiemetic use in the patients who received 5-aminolevulinic acid were 9.5% and 4.1%, respectively, and higher than in those who did not (0% and 0%; P < 0.01 and P = 0.04, respectively). Postoperative NV (25.7%) and antiemetics use (8.0%) ratios in the patients who received 5-aminolevulinic acid were significantly different from those in the non-users group (3.6% and 2.1%, P < 0.01 and P < 0.01, respectively). Although no differences in risk factors were found for postoperative NV between the two groups, multivariate analyses indicated 5-aminolevulinic acid use as an independent predictive factor for postoperative NV (odds ratio, 11.5; 95% confidence interval, 3.98–33.3; P < 0.01). ConclusionsOur study clearly showed that oral administration of 5-aminolevulinic acid was associated with perioperative NV even without risk factors, highlighting the need for addressing its application.

Overview of premedication prescription and intake in an oncology day hospital: What do we need to change to improve patient management?

Premedication of cancer therapy against nausea and vomiting (NV) and hypersensitivity reaction (HS) is essential for good patient management. However, this prescription is not always optimal. Today, as a large part of cancer therapies are administered in day hospitals (DH), premedication taken on the day of the cancer treatment is injected as a 30-min infusion. To assess compliance with recommendations for premedication prescription and intake; to analyse patient attitude about switching to exclusively oral forms taken at home. The study is conducted in the medical oncology DH of a French Hospital from 17 January to 25 February 2022. The data collection is carried out as an individual interview, associated with the distribution of two questionnaires. Data are coupled with the premedication set up on our software and the last medical report. Intakes are considered optimal when recommendations, tolerance, background, and adherence of the patient are taken into account. Seventy patients were included for interviews. Regarding software prescriptions, our configuration was consistent with recommendations in 100% of cases for HS and 37% for NV. Intakes were compliant in 51.4% of cases, non-compliant in 17.1% and debatable in 31.5%. Disparities between the practices of different physicians were identified. Regarding the feasibility of oral substitution, it could concern 63.5% of patients. This work makes it possible to improve the management of all patients and to make the operation of the care unit more fluid.

Quality of Life and Sense of Coherence in Cancer Patients of German, Turkish and Polish Origin-A Cross-Sectional Study.

Due to a variety of symptoms and side-effects of cancer treatment, quality of life can be considerably impaired in cancer patients. Especially, cancer patients with a migration background seem to be at risk. The objective of our study is to investigate the quality of life and sense of coherence in adult cancer patients of German, Turkish and Polish origin. We assessed sociodemographic, migration-specific and cancer-related parameters. Quality of life was measured via the EORTC QLQ-C30, sense of coherence was measured with the SOC-13. We included 227 patients in the study (59.5% native Germans, 40.5% with migration background). Native Germans did not differ in quality of life compared to all migrants. However, more nausea and vomiting (NV) and higher appetite loss (AP) was found in Turkish migrants compared to Polish migrants and native Germans. For sense of coherence, we observed significantly higher scores for native Germans compared to all migrants. Turkish migrants had significantly lower scores compared to native Germans. A Turkish migration background seems to play an important role in the perception of symptoms, especially of nausea and vomiting and appetite loss. Culture-specific aspects should be considered in cancer care.

Dynamic changes in the body composition during chemotherapy for gastrointestinal tumors in the context of active nutrition intervention.

To explore the dynamic changes in the body composition during chemotherapy in patients with gastrointestinal malignancies in the context of active nutrition intervention. Patients with gastrointestinal malignancies receiving first-line chemotherapy in the Department of Medical Oncology of Ordos Central Hospital from September 2019 to January 2022 were included in this study. The Nutritional Risk Screening form 2002, Patient-Generated Subjective Global Assessment form, bioelectrical impedance analysis, and dynamic changes in L3 skeletal muscle index (SMI) (L3SMI) were assessed at baseline and after chemotherapy. The recommended protocol of the Nutrition Guidelines for Cancer Patients in China 2020 was adopted as the active nutrition intervention. Chemotherapy-related toxic adverse reactions and the degree of toxicity were recorded with the adoption of the Common Terminology Criteria for Adverse Events version 4.0 by the National Institutes of Health. The type of toxicity Chemotherapy-Induced Nauseaand Vomiting(CINV) and hematological. Fifty cases were enrolled in the study, and 38 cases completed the dynamic follow-ups. The average follow-up time was 125.63d. In the context of active nutrition intervention, the prevalence of sarcopenia decreased from 26.3% before chemotherapy to 21.1% after chemotherapy. The average L3SMI decreased from 38.77 cm2/m2 to 38.04 cm2/m2, with a reduction of 1.41% ± 8.49% (P = 0.177). The SMI remained stable or increased in 57.9% (22/38) of patients. The benefit of active nutrition intervention was greater in the sarcopenic group than in the non-sarcopenic group (P = 0.033). There was an increased incidence of chemotherapy-related toxic adverse reactions of ≥ grade 3 during chemotherapy in the sarcopenic group compared with the muscle retention/gain group (P = 0.089). Active nutrition intervention might decrease the degree of reduction of L3SMI and the incidence of sarcopenia in patients with gastrointestinal tumors and raise the proportion of patients with stable or increased SMI during chemotherapy.

Premedication of Oral Clonidine 2mcg/kg and 4mcg/kg for Analgesic and Pressure Response During First Twenty-four Hours After Upper Abdominal Surgery: A Comparative Study

Traditionally postoperative period analgesia was maintained by opoids and which frequently increasethe hospital stay time and cost by delayed bowel movement and others side effects. on the other handupper abdominal surgery is very much painful, usually Opiods are used as good analgesic, but havesome adverse effect and addiction effect; anaesthesiologists want to reduce its requirements. In upperabdominal surgery adequate analgesia, stable haemodynamic, early bowel movement, free from nauseaand vomiting is wanted, as a part of multimodal analgesic approach, premedication by clonidine is veryimportant for it analgesic, angiolytic and sedative properties. Alpha two (α–2) adrenoreceptor agonist,Clonidine exerts central sympatholytic effect for 8 to 10 hours as its half life is 9-12 h. So thatpremedication with oral clonidine causes reduction of anxiety, reduction of perioperative analgesicdrugs and also reduction of anaesthetic doses. In addition, clonidine increases cardiac baroreceptorreflex sensitivity to increase in systolic blood pressure, and thus stabilizes blood pressure. Clonidine israpidly and almost completely absorbed after oral administration with a time to maximum plasmaconcentration of between 1.5 and 2 hr and elimination half-life of 8 to 12 hr. But clonidine producesanalgesia in a dose dependent manner, achieving complete pain relief for up to 5 hours without sensoryor motor block at large doses (oral 7000 to 900 mcg) however large doss were associated withdisadvantage including hypotension, bradycardia and transient sedation. It also reported thatclonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient afterorthopedic surgery. Because of its dose, route, and surgical variation it is very much important tospecify the dose for upper abdominal surgery.The primary aim of this study to compare the effects of clonidine premedication at different doses (2 &amp;4mcg/kg) on postoperative analgesia and hemodynamic status in upper abdominal surgery with largeincision area. (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipplesoperations). JBSA 2022; 35 (2) : 17-21

To Compare the Effectiveness of Granisetron Versus Ondansetron to Control Nausea and Vomiting During Lower Segment Cesarean Section Under Subarachnoid Block.

Nausea and vomiting (NV) seen during and after lower segment cesarean section (LSCS) are due to increased intragastric pressure, hypotension, stretching the peritoneum (exteriorization of the uterus), excessive surgical manipulation and visceral stimulation, using opioids, using uterotonic agents, and the patient's mental status. Ondansetron and granisetron intravenous (i.v.) are useful for avoiding bradycardia and hypotension. The objective of this study is to study the effectiveness of granisetron versus ondansetron to control NV during LSCS under subarachnoid block. Eighty patients undergoing elective cesarean section under spinal anesthesia by intrathecal bupivacaine were randomly divided into two groups (40 pregnant females of the American Society of Anesthesiologists physical status Classes I and II in each Group). Group 1 received granisetron 40 mg.kg-1 i.v. stat after clamping the cord and Group 2 given i.v. ondansetron 8 mg stat after clamping the cord. NV were observed at the "early postoperative period (0-3 h)" and "late postoperative period (4-24 h)." Student's t-test and Chi-square test were used to find out the statistical significance, P < 0.05 was considered statistically significant. The mean age was 29.3 years with 4.15 standard deviation (SD) and 28.3 years with 4.41 SD in Groups 1 and 2, respectively. The mean duration of surgery was 53.1 min with 6.67 min SD and 57.7 min with 10.26 SD in Groups 1 and 2, respectively. In the "early postoperative period," NV observed in 7.5% and 10.0% participants in Groups 1 and 2, respectively (P > 0.05), and in "late postoperative period," NV observed in 0.0% and 22.5% participants in Groups 1 and 2, respectively (P < 0.05). Granisetron reduces the severity of spinal-induced hypotension, need for rescue vasopressor, and incidence of nausea.

Mosapride Citrate Combined with Divine Qu Disinfectant Oral Liquid for Children Function Dyspepsia and the Influence of Serum Factors.

In order to investigate the efficacy of mosapril citrate combined with ShenQu Xiaoshi oral liquid in the treatment of children with functional dyspepsia and the effect on serum cytokines, 136 children with functional dyspepsia admitted from May 2017 to September 2020 were divided into 2 groups randomly, 68 cases in each group. The western medicine group was treated with mosapril citrate tablets, and the combined group was treated with Shenqu xiaoshi oral liquid on the basis of the western medicine group. The efficacy of patients was evaluated 14 days after treatment, and the safety, symptom score, and serum cytokines of the two groups were compared. The results showed that, after 14 days of treatment, the scores of abdominal distension and abdominal pain (ADAP), lack of food (LOF), nausea and vomiting (NAV), irregular stool (IS), and mental fatigue (MF) in the combined group were all lower than those in the western group (P < 0.05). There was no statistical significance in the incidence of diarrhea, abnormal liver and kidney, and allergic rash between the two groups (p > 0.05). In conclusion, mosapride citrate tablets combined with Shenqu Xiaoshi oral liquid can achieve good therapeutic effects in children with functional dyspepsia, reduce symptom scores, improve serum cytokine levels, and have high drug safety, which is worthy of promotion and application.

Multicenter, randomized double-blind placebo-controlled trial of definitive concurrent chemoradiotherapy plus megestrol acetate/placebo in local-advanced esophageal cancer.

275 Background: To determine Quality-of-Life (QoL) improvement by Megestrol Acetate (MA) in local advanced esophageal squamous cell carcinoma (ESCC) with definitive concurrent chemoradiotherapy (DCRT). Secondary aims were to examine the safety and the impact of MA on the efficacy of DCRT. Methods: Patients (with previously untreated T1bN+M0 or T2-4aN0-2M0 ESCC) were randomly assigned at a one-to-one ratio to receive MA or placebo (blind). All received 5-FU based chemotherapy with concurrent radiotherapy (50Gy/25F). QoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaires at pretreatment and 3, 6, 16 weeks of DCRT. The good status (GS) rate of appetite loss (AL), nausea and vomiting (NV), weight (WT) and performance status (PS) were chosen as predefined primary end points. GS defined as the score were ≤ 0 for AL or NV and ≥ 0 for WE or PS when the designed time points compared with last one. Secondary end points were the comprehensive QoL (remaining items of QLQ-C30 changes analysis at 16th week), myelosuppression (MS), and deep vein thrombosis (DVT). The exploratory end points were the objective response rate (ORR), 1-year overall survival (OS) and progression-free survival (PFS). Results: 84 completed the follow-up and were analyzed from which 120 patients randomly assigned. The GS rates of AL (3th week: P = 0.011; 6th week: P &lt; 0.001; 16th week: P = 0.001), NV (6th week: P = 0.001) and PS (6th week: P = 0.01) were higher in MA than Placebo. There were no statistical differences between MA and Placebo on WT. At 16th week, the change degree analysis shown the fatigue was worse in MA than Placebo ( p = 0.031). There were no differences on MS, DVT, ORR, OS and PFS between two arms. Nevertheless the rate of DVT was slightly higher in MA than Placebo (12.5% vs. 2.8%, P = 0.113). Conclusions: MA is helpful for ESCC patients receiving DCRT as well as the risk of DVT needed be careful.

Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients

Objective: To investigate and compare the safety and efficacy of the empirical use of Histamine-2-receptor antagonists (H2RAs) and Proton pump inhibitors (PPIs), for the treatment of unspecified nausea and vomiting (NV) in hospitalized children.&#x0D; Methods: The retrospective cohort study was conducted at King Abdulaziz Medical City in Riyadh (KAMC-R) and included pediatric patients ≤14 years who received acid suppression therapy (AST), H2RAs or PPIs, for the treatment of unspecified NV between April 30, 2018, and April 30, 2019. The primary outcome was the complete resolution of NV within three days of AST. The secondary outcomes were the frequency of rescue medication use, the number of vomiting episodes since starting the AST, and the adverse drug reactions (ADRs).&#x0D; Results: Sixty-two patients were included in the study, 25 (40.3%) were in the H2RAs group and 37 (59.7%) in the PPIs group. The mean age was 3.69 ± 4.13 years, with the majority male (64.5%). Overall, 87% (n=54) of the sample had complete resolution of NV within 3 days of the AST therapy with no difference between the H2RAs and PPIs groups (p=0.344). The number of NV episodes from initiating the AST until the complete resolution was similar between the groups. In total, 14 patients (25.9%) required rescue therapy with granisetron, 6 (26.1%) in the H2RAs group compared to 8 (25.8%) in the PPIs group. There was no difference in the number of the required granisetron doses or the incidence of ADRs.&#x0D; Conclusion: Both PPIs and H2RAs were effective and safe for the treatment of unspecified NV in hospitalized pediatric patients. The selection of either agent should be based on other factors.&#x0D; Keywords: Pediatric; Nausea and vomiting; Proton pump inhibitor; Histamine-2-receptor antagonist; Granisetron.

The Effect of Self-Nutrition Management Combined with Mindfulness Intervention on Postoperative Nutritional Status and Quality of Life of Patients Undergoing Radical Gastric Cancer Surgery

Background Gastric cancer patients after surgery due to surgical trauma, digestive tract reconstruction of negative emotions and other factors, resulting in reduced postoperative food intake, nutritional status decreased immune function, resulting in tumor escape and postoperative recurrence or metastasis. Self-nutrition management combined with mindfulness intervention has a positive effect on postoperative nutritional status and quality of life of patients. Objective To analyze the effect of self-nutrition management combined with mindfulness intervention on postoperative nutritional status and quality of life of patients undergoing radical gastric cancer surgery. Methods A total of 130 gastric cancer patients admitted to our hospital from October 2018 to February 2021 were selected and divided into groups according to their intervention plan. All 130 patients were treated with laparoscopic radical resection of gastric cancer, 65 patients in the control group were given routine nutritional intervention and nursing intervention, and 65 patients in the observation group were given self-nutrition management intervention and mindfulness intervention. The postoperative rehabilitation indicators, hospitalization expenses and complications were compared between the two groups, and the changes in nutritional indicators between the two groups were detected. The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) were used to evaluate negative emotions. The European the Cancer Research and Treatment Organization Quality of Life Scale (QLQ-C30) evaluates the quality of life. Results The observation group’s first exhaust time, oral feeding time, and hospital stay were shorter than those in the control group. Compared with the control group, there was no significant difference in hospitalization expenses (P&gt;0.05). Compared with before the intervention, the ALB, PA, and TRF of the two groups were increased (P&lt;0.05), and the improvement of nutritional indicators in the observation group after the intervention was more obvious than that of the control group (P&lt;0.05). Compared with before the intervention, the SDS scores and SAS scores of the two groups decreased (P&lt;0.05), and the negative emotion scores of the observation group improved more significantly than those of the control group after the intervention (P&lt;0.05). Compared with the pre-intervention, the two groups of QLQ-C30 scores in the areas of general health, physical function, role function, emotional function, social function and economic difficulties, etc. scores increased (P&lt;0.05), fatigue, insomnia and loss of appetite, ect. The score decreased (P&lt;0.05). There was no significant difference between the two groups in the areas of cognitive function, nausea and vomiting, constipation, diarrhea, etc. (P&gt;0.05). In the area of pain and shortness of breath, observe the group was lower than before the intervention, but the difference between the control group and before the intervention was not statistically significant (P&gt;0.05). The QLQ-C30 scores of the observation group after intervention (except in areas such as cognitive function, nausea and vomiting, constipation, diarrhea, financial difficulties, etc.) generally improved significantly compared with the control group (P&lt;0.05). The incidence of complications in the observation group was lower than that in the control group, which was statistically significant (P&lt;0.05). Conclusion Self-nutrition management combined with mindfulnesspromote postoperative recovery, reduce complications and negative emotions, improve nutritional status, and improve quality of life.

Thyroid Surgery in Local Anaesthesia: Renewal an Old Method

Introduction: In the older times of thyroid surgery, the operations were performed under local anaesthesia. With the development of anaesthesia surgeons preferred to use narcosis for most thyroid surgeries. Today, however, regional anaesthesia has become popular as a safe and effective technique based on numerous clinical studies, surgeons are still keen on doing surgeries under general anaesthesia. Regional anaesthesia is indicated in high risk patients and also in case of pregnancy, but in well-fit patients it could lead to faster recovery. In case of a substernal goitre or infiltrating carcinoma or in case of severe bleeding disables general anaesthesia should be chosen. Patient materials and methods: At the Department of Multidisciplinary Head and Neck Cancer Center in the National Institute of Oncology between May 2019 and March 2020, 9 patients underwent thyroid or parathyroid operations in regional anaesthesia: 7 patients had lobectomy, 1 patient had thyroidectomy, and 1 patient had parathyroid adenoma removal. In all cases, the regional anaesthesia involved the blockage of the superficial branches of the cervical plexus, followed by an ultrasound guided thyroid capsule sheath space block. Patients were previously given 2 mg of i.v. midazolam, and in case of need 50 ug of i.v. fentanyl under haemodynamic monitoring. Results: One patient had a transient Horner’s syndrome. The average time of the surgery was 42.7 minutes (25-80 minutes). All patients tolerated the procedures very well. The incidence of postoperative pain, such as nausea and vomiting were reduced. Patients could be discharged earlier and they had a faster recovery. Conclusion: Based on our limited experience, regional nerve block anaesthesia for uncomplicated thyroid and parathyroid patients offers several advantages, and provides superior postoperative nausea, and pain control.

Effect of Compression Stockings on Morning Sickness among Primigravidas

Background: Morning sickness during pregnancy can range from mild discomfort to significant morbidity that leads to certain complications for mother and fetus. Therefore, this study aimed to assess the effect of compression stockings on morning sickness among primigravidas. Materials and Method: A Quazi experimental research design was used. The study was conducted at the obstetric outpatient clinic of National Medical Institute in Damanhour, El-Behiera Governorate. A purposeful sample of 80 pregnant women was recruited. Subjects who fulfilled the inclusion criteria were assigned to one of the two equal groups: study and control group. Four tools of data collection were used: A structured interview questionnaire, visual analogue scale (VAS) for severity of nausea and vomiting, (NVPQOL) nausea, vomiting pregnancy quality of life and pregnancy unique quantification of emesis and vomiting (PUQE). Results: There was a highly statistically significant differences after two weeks intervention between the study and control group regarding the severity of nausea and vomiting, (P=0.000).There was severe effect of morning sickness on women’s quality of life among both study and control group before intervention (77.5% and 75%) respectively. However, there was a greater improvement after the period of compression among the study group and there was a statistically significant differences between the study and control groups post intervention, P=.000. Conclusion: From the results of the current study, it can be concluded that morning sickness decreased among women who used compression stockings for two weeks during early pregnancy. Recommendation: Emphasize the use of compression stockings in the non pharmacological protocol for the treatment of NVP as an effective strategy for such a problem

Evaluation of the incidence of acute nausea and vomiting after administration of an amino acid solution containing only arginine and lysine with lutetium Lu-177 dotatate.

12113 Background: Lutetium Lu-177 dotatate is used to treat patients with gastroenteropancreatic neuroendocrine tumors, and an amino acid (AA) solution must be administered concurrently to mitigate nephrotoxicity. AA solutions may lead to increased rates of nausea and vomiting (NV) due to the inclusion of unnecessary non-essential and essential AA. Methods: This study is a single academic center retrospective chart review from October 6th, 2015 to December 17th, 2019 evaluating the incidence of acute NV in adult patients after administration of an AA solution containing only arginine 25 grams and lysine 25 grams in 1 liter of normal saline (Arginine-Lysine amino acid [AL AA]) with lutetium Lu-177 dotatate. The incidence of acute NV will be compared to the historical incidence in patients administered Parenteral amino acids 10%, Aminosyn II 10% or Clinisol 15% (commercial AA). Secondary endpoints include the incidence of rescue anti-emetic usage and the percentage of patients that require interruption of the AA infusion. Acute NV are defined as any occurrence of NV within twenty-four hours of the AA infusion. Results: 53 patients received a total of 164 treatments with the AL AA, while 18 patients received a total of 48 treatments with the commercial AA. The AL AA significantly decreased the incidence of acute NV, the mean AA infusion time, the interruption of the AA infusion, and the utilization of rescue anti-emetics compared to the commercial AA (Table) in patients on lutetium Lu-177 dotatate. Conclusions: The study findings support the use of an AL AA to be administered concurrently with lutetium Lu-177 dotatate to minimize commercial AA related acute NV. [Table: see text]

A Comparative Study of Single Dose Dexamethasone versus Ondansetron for control of Post Operative Nausea and Vomiting after High-Risk Surgeries

The occurrence of postoperative nausea and vomiting is generally associated with anesthesia and surgery. The problem is compounded in cases of high-risk surgeries where the incidence is quite high. The present study was designed to compare the efficacy of Dexamethasone and Ondansetron. Methods: This study was undertaken at the Prathima Institute of Medical Sciences, Naganoor, Karimnagar. In this randomized, open clinical trial, we studied 80 ASA grades I to 1V patients of age group 20-60 years undergoing Laparoscopic Laparotomy, Major Gynecological surgeries, Renal, Shoulder and ENT surgeries under general anesthesia. The patients were randomly divided into two groups, Group I and Group II, each consisting of 80 patients. Group I received 4mg dexamethasone intravenous (IV) just after intubation and group II received 4mg Ondansetron intravenous (IV), just before extubation. Results: The most common age group was 50 – 59 years which had n=45(28.1%) patients out of which group I was n=24(15%) patients and n=21(13.1%) patients. The next common age group was 20 – 29 years out of which n=23 (14.4%) and n=18(11.2%). ondansetron group, early nausea is mild in 6.9%, moderate in 3.8%, and severe in 1.2% of patients. Whereas in the dexamethasone group early nausea is mild in 6.2%, moderate in 4.4%, severe in 1.9% of patients. In the ondansetron group, late nausea is mild in 9.4%, moderate in 3.8%, and severe in 0.6% of patients. Whereas in the dexamethasone group late nausea is mild in 7.5%, moderate in 4.4%, severe in 0.6% of patients. In the ondansetron group, early vomiting is mild in 5.0%, moderate in 0.6%, and severe in 0.6% of patients. Whereas in the dexamethasone group early vomiting is mild in 4.4%, moderate in 1.2%, severe in 0.6% of patients. Conclusion: dexamethasone given intravenously just after intubation and ondansetron given intravenously just before extubation are safe and have similar efficacy in postoperative nausea and vomiting after elective surgeries under general anesthesia having a high risk of PONV

A COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND TRAMADOL FORPOSTOPERATIVE ANALGESIA IN ORTHOPEDIC LOWER LIMB SURGERIES

Post operative pain management is a challenge in anaesthesia practice. Many opioids are available for epidural use with various side effects. The main objectives of the study is to asses and compare the postoperative analgesia and quality of analgesia with epidural butorphanol or tramadol in patients undergoing orthopaedic lower limb surgeries. 100 patients of either sex, belonging to 20-60 yrs of age, ASA grade I and II admitted for orthopedic lower limb surgeries were included in the study. In the post-operative period when the patients visual analogue score >4 received either 1 mg of butorphanol (group B) or 50 mg of tramadol (group T) diluted to 10 ml with normal saline. We monitored and compared the Onset ,Duration , Quality of analgesia, consciousness, Cardio-respiratory and Side effects. the mean time of onset of analgesia in group-T was 13.28±2.04 min and in group-B was 11.20±1.02 min, which is statistically significant(p<0.01). The duration of action of analgesia in group-T was 369.8±25.6 min and in group-B was 215.2±26.0 min which is Statistically significant as ‘p’ value is <0.01. Quality of Analgesia (VRS) was better with butorphanol group. The Quality of Analgesia (VRS) in group-T was 3.22±0.54 (SD) min and in group-B was 3.62±0.49 (SD) min (p<0.01) which is statistically significant. Sedation Score was significantly higher with butorphanol group at first hour(P<0.01). Tramadol group had significantly higher incidence of nausea and vomiting(P,0.01). In conclusion epidural butorphanol is better then epidural tramadol for post-operative analgesia. Epidural butorphanol produces faster onset of analgesia , but the duration of analgesia is lesser when compared to tramadol . Side effects like nausea and vomiting are less in butorphanal group but sedation score was higher. Patient satisfaction was better in butorphanol group

Postoperative Nausea and Vomiting: Risks, Prophylaxis, Non-Drug Alternative Methods

Nausea and vomiting are among the most common complaints in the postoperative period. The type of surgical technique and the site of intervention, as well as the anesthetic drugs and methods directly contribute to the rates of postoperative nausea and vomiting (PONV). One of the most important factors affecting the frequency of postoperative nausea and vomiting is the anesthetic drugs and methods used. Many antiemetic drugs are used to prevent postoperative nausea and vomiting. With the use of these drugs, side effects especially such as delayed recovery from anesthesia, dry mouth, undesirable changes in blood pressure and the occurrence of extrapyramidal symptoms are seen. Several antiemetic drugs are commonly used for the treatment of postoperative nausea and vomiting; including scopolamine, chlorpromazine, diphenhydramine, metoclopramide, promethazine, and ondansetron. Low-dose haloperidol and metoclopramide are effective in opioid-induced nausea and vomiting. Dexamethasone reduces the incidence of postoperative nausea in the first 6 hours after surgery. Oral intake starts in patients with severe vomiting parenteral fluid and electrolyte treatment is required. Sometimes provide may need gastric decompression with nasogastric tube. Parenteral fluid and electrolyte treatment and in severe cases gastric decompression with a nasogastric tube may be necessary. Alternative medicine such as acupuncture and acupressure can help prevent or reduce postoperative nausea and vomiting. The aim of this review is to examine the medical therapies and drug-free methods used for the treatment of PONV in the light of the literatüre

Impact of Addition of Carboplatin AUC ≥ 4 to Antiemetic Guidelines for Triple Antiemetic Prophylaxis: A Gap in Quality of Care, Guideline Adoption, and Avoiding Acute Care.

After ASCO and National Comprehensive Cancer Network guideline recommendations for triple antiemetic prophylaxis for carboplatin area under the curve (AUC) ≥ 4, and the publication of studies documenting avoidable acute care after chemotherapy involving nausea and vomiting (NV) and other toxicities, we studied clinician adherence to the guideline change and assessed avoidable acute-care use. Using a large electronic health record database, we evaluated antiemetic prophylaxis as recommended in the guidelines and post-chemotherapy avoidable acute-care use (defined as involving any of NV or 8 other toxicities) for patients initiating carboplatin or other chemotherapy from October 2012 to August 2018. We identified 11,554 carboplatin courses. After the guideline change adding neurokinin-1 receptor antagonists (RAs) for carboplatin AUC ≥ 4, its use rose to 20% of courses from the prior average of 16%; virtually all courses also included a 5-HT3 RA plus dexamethasone. We found avoidable acute care in 23% of courses; one quarter of these events were associated with NV. Acute care rates after carboplatin mirrored those after other highly emetogenic chemotherapy or oxaliplatin and exceeded those after other chemotherapy regimens. The > 80% shortfall in adherence may have been caused by low awareness or acceptance of the guideline change and/or by poor awareness of avoidable acute-care use after carboplatin. Neurokinin-1 RA prophylaxis for carboplatin AUC ≥ 4 remains low and largely unchanged despite National Comprehensive Cancer Network and ASCO 2017 recommendations for inclusion. NV and avoidable acute care involving NV seen after carboplatin were consistent with other highly emetogenic chemotherapy. Clinician action is required to remediate incomplete prophylaxis and to no longer place patient outcomes, resources for cancer treatment, and clinician reimbursement at risk.

The Relevance of the OPRM1 118A&gt;G Genetic Variant for Opioid Requirement in Pain Treatment: A Meta-Analysis

Background: There is obvious difference in individual response to opioids. Many studies have examined the correlation between the μ-opioid receptor 1 (OPRM1) 118A&gt;G genetic variation and opioid requirement in pain treatment, but the conclusion remains elusive. Objectives: To investigate whether the OPRM1 118A&gt;G genetic variation is associated with the opioid requirement. Study Design: Systematic review and meta-analysis. Methods: PubMed, Cochrane library, and EMBASE databases were systematically searched up to May 5, 2018, using the keywords “OPRM1,” “genetic variant,” “opioid,” and “pain” to identify reviews or meta-analyses on this topic. Two independent reviewers performed the data extraction and assessed study quality. The authors investigated the standardized mean difference (SMD) of opioid requirement between AA homozygotes and G allele carriers. The authors also examined the association between the OPRM1 118A&gt;G genetic variation and adverse effects such as nausea and vomiting. Potential bias was assessed using the Egger’s test and the Begg’s test. Results: A total of 530 articles were retrieved from the databases searched, and 36 studies involving 8,609 patients were included in the final analysis. G allele carriers required a higher mean opioid dose (SMD: 0.17; 95% confidence interval [CI]: [0.12, 0.22]; P &lt; 0.001) and displayed less nausea risk difference (RD): –0.04; 95% CI: [–0.06, –0.01]), but the incident rate of vomiting has no relationship with the genetic variant than AA homozygotes in a random-effects meta-analysis. Although there was no evidence of publication bias (Begg’s test: P = 0.333; Egger’s: P = 0.561), heterogeneity was present among studies (I2 = 54.3%). In the subgroup meta-analyses, there was also significance observed in the postoperative pain setting. Limitations: In all of the articles reviewed, postoperative pain and cancer pain were mostly discussed except for one in other pain setting. Conclusions: In this meta-analysis, the results indicate the OPRM1 A118G polymorphism was associated with the opioid requirement and the adverse effects in pain treatment especially in postoperative pain. This may provide valuable information for clinicians to adopt personalized pain management by properly using the opioids in individual patients. Key words: OPRM1, genetic variation, opioid, pain, side effect, review, meta-analysis