Use Of Ondansetron Research Articles

The Effect of Forced-Air Warmer, Ondansetron or their Combination on Shivering in Pregnant Women Coming for Elective Cesarean Section under Spinal Anesthesia: A Prospective, Randomized Controlled Comparative Study.

Context:Perioperative shivering can occur in up to 85% of patients undergoing cesarean section under spinal anesthesia. It has many detrimental effects and disrupts early mother-child bonding. Therefore, it should ideally be prevented by either pharmacologic or nonpharmacological means.Aims:The primary aim of this study was to evaluate the efficacy of intraoperative forced-air warming, ondansetron or their combination in preventing perioperative shivering in patients undergoing elective cesarean section under spinal anesthesia.Settings and Design:A prospective randomized controlled comparative study done at the tertiary care center.Subjects and Methods:A total of 120 patients undergoing elective cesarean section under spinal anesthesia were randomly assigned to three groups. Group O received ondansetron 4 mg intravenously (i.v.) after giving block with no forced air warming. Group W received forced-air warming intraoperatively. Group C received ondansetron 4 mg i.v. after giving block plus intraoperative forced-air warming. Core temperature (tympanic membrane) and the arm skin temperature were measured and shivering was graded simultaneously.Statistical Analysis Used:Parametric data were analyzed using one-way ANOVA and Student's paired t-test where ever appropriate. Nonparametric data were analyzed using the Kruskal–Wallis and the Chi-square test. Values of P < 0.05 were considered statistically significant.Results:Shivering incidence was higher in Group O and Group W being 17.5% and 20%, respectively, and least in Group C being 5%. The incidence of Grade ≥3 shivering requiring rescue drug was lower in Group C (2.5%) compared to that of the Groups W (5%) and O (10%) but was not statistically significant (P = 0.21).Conclusions:Combined use of ondansetron and forced- air warmer was more effective in reducing the incidence of shivering in pregnant women during elective cesarean section than when used individually.

Ondansetron Is an Effective Alternative to Decrease the Incidence of Postspinal Hypotension in Healthy Subjects Undergoing Infra-Umbilical Surgeries Compared To Combined Volume Loading and Vasoconstrictors: Randomized Controlled Trial.

BACKGROUND:One of the important and predicted physiological effects of spinal anaesthesia is hypotension. A range of strategies including mechanical interventions, intravenous fluids and vasoconstrictor drugs have been used to minimise or prevent spinal anaesthesia-induced hypotension. Observational studies suggest that ondansetron reduces the incidence of post-spinal hypotension (PSH) and support the use of combined fluid preloading and vasoconstrictors for this purpose (but with limited doses) to avoid side effects as fluid overload and tachycardia respectively.AIM:As no RCT had ever compared the use of Ondansetron alone with combined vasoconstrictors and fluid preload, so, this randomised controlled trial has evaluated the efficacy of the use of ondansetron alone compared to the combined use of fluid preload and vasoconstrictors to decrease the incidence of spinal hypotension.METHODS:Ninety patients of ASA grade I between the age of 18 and 45 years scheduled to undergo elective surgical procedures on the lower extremity or lower abdomen under spinal anaesthesia were included in the study. The patients were randomly allocated into two groups of 45 each. Group I patients (ondansetron group) received 4 mg ondansetron in 5 ml normal saline (IV) 15 minutes before induction of spinal anaesthesia. Group II patients (combination group) received preloading with 7.5 ml/kg/min of Ringer’s lactate over 10 minute period preceding the spinal block followed by intravenous bolus of 2.5 mg ephedrine in the first and second minute and 2.5 mg ephedrine every 5 minutes for the next 20 minutes after the injection of spinal anesthetic drug. Non-invasive measurement of mean arterial pressures, heart rate, reactive hypertension, nausea and vomiting were documented.RESULTS:The incidence of hypotension following the subarachnoid block in Group I (ondansetron group) was 17.6% versus group II (combination group) was 13.3%, while difference among the groups is statistically insignificant (P = 0.082). Group IV fluids alone could reverse hypotension in 57.1% of patients in group I 33.3% in group II. 42.9% of patients in group I and 67.7% in group II could not be managed with IV fluids alone and had to be treated with 5 mg boluses of ephedrine for reversal of hypotension. The difference in the mean number of fluid boluses and a dose of ephedrine used between both groups was statistically insignificant (P = 0.11 and P = 0.21). HR showed a significant increase in group II and a statistically insignificant change in group I with a statistically significant difference in the heart rate (HR) between both groups (P < 0.05). Reactive hypertension, nausea and vomiting between both groups were statistically insignificant.CONCLUSION:The preemptive use of Ondansetron alone versus combined vasoconstrictors with fluid preload significantly reduces the incidence of post-spinal hypotension (PSH) with no significant difference between both regimens. Furthermore, they also reduced consumption of the used vasoconstrictors and fluids to correct hypotension.

Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring

Evidence for the fetal safety of ondansetron, a 5-HT3 receptor antagonist that is commonly prescribed for nausea and vomiting during pregnancy, is limited and conflicting. To evaluate the association between ondansetron exposure during pregnancy and risk of congenital malformations. A retrospective cohort study nested in the 2000-2013 nationwide Medicaid Analytic eXtract. The cohort consisted of 1 816 414 pregnancies contributed by 1 502 895 women enrolled in Medicaid from 3 months before the last menstrual period through 1 month or longer after delivery; infants were enrolled in Medicaid for at least 3 months after birth. The final date of follow-up was December 31, 2013. Analyses were conducted between November 1, 2017, and June 30, 2018. Propensity score stratification was used to control for treatment indication and other confounders. Ondansetron dispensing during the first trimester, the period of organogenesis. Primary outcomes were cardiac malformations and oral clefts diagnosed during the first 90 days after delivery. Secondary outcomes included congenital malformations overall and subgroups of cardiac malformations and oral clefts. Among 1 816 414 pregnancies (mean age of mothers, 24.3 [5.8] years), 88 467 (4.9%) were exposed to ondansetron during the first trimester. Overall, 14 577 of 1 727 947 unexposed and 835 of 88 467 exposed infants were diagnosed with a cardiac malformation, for an absolute risk of 84.4 (95% CI, 83.0 to 85.7) and 94.4 (95% CI, 88.0 to 100.8) per 10 000 births respectively. The absolute risk of oral clefts was 11.1 per 10 000 births (95% CI, 10.6 to 11.6; 1921 unexposed infants) and was 14.0 per 10 000 births (95% CI, 11.6 to 16.5; 124 exposed infants). The risk of any congenital malformation was 313.5 per 10 000 births (95% CI, 310.9 to 316.1; 54 174 unexposed infants) and was 370.4 (95% CI, 358.0 to 382.9; 3277 exposed infants). The adjusted relative risk (RR) for cardiac malformations was 0.99 (95% CI, 0.93 to 1.06) and the adjusted risk difference (RD) was -0.8 (95% CI, -7.3 to 5.7 per 10 000 births). For oral clefts, the adjusted RR was 1.24 (95% CI, 1.03 to 1.48) and the RD was 2.7 (95% CI, 0.2 to 5.2 per 10 000 births). The adjusted estimate for congenital malformations overall was an RR of 1.01 (95% CI, 0.98 to 1.05) and an RD of 5.4 (95% CI, -7.3 to 18.2 per 10 000 births). Among offspring of mothers enrolled in Medicaid, first-trimester exposure to ondansetron was not associated with cardiac malformations or congenital malformations overall after accounting for measured confounders but was associated with a small increased risk of oral clefts.

Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial.

Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. Randomised controlled double blind trial. Two University Hospital Centres and two private Clinics from January to September 2014. Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group, and 3/87 (3.4%) in droperidol 1.25 mg group. The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. Clinicaltrials.gov: NCT01942343.

Effectiveness of Alizapride for Prophylaxis of Nausea and Vomiting after Spinal Anesthesia for Cesarean Section

Background: Nausea and vomiting are common side effects in parturients undergoing cesarean delivery performed under spinal anesthesia can be very unpleasant to the patients. The reported incidence of nausea and vomiting during cesarean performed under regional anesthesia varies from 50% to 80% when no prophylactic antiemetic is given. Therefore, use of prophylactic antiemetics in parturients undergoing cesarean delivery is recommended by some authors. Objective: In this study, alizapride was evaluated, as a D2 receptor antagonist, on the prevention of nausea and vomiting following Spinal Anesthesiain parturients undergoing elective cesarean section. Patients and Methods: The study was carried out in AL-Azhar University Hospitals, Obstetric and gynaecology department on 90 patients undergoing an elective, lower segment cesarean section (LSCS). All patients were identified by code number to maintain the privacy of the patients. Any unexpected risks appeared during the course of the research was cleared to the participants and the ethical committee on time. A written informed consent was obtained from all patients. Patients were divided into 3 groups, 30 patients for each group. Group I (Alizapride 50 group): Received intravenous (IV) Alizapride 50 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group II (Alizapride 100 group): Received intravenous (IV) Alizapride 100 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group III (Saline group): Received normal saline 10 ml, immediately after clamping umbilical cord. Results: The incidence of nausea and vomiting was significantly decreased in group 2 (Alizapride100 group) compared with group 1 (Alizapride 50 group) and both group was better than group 3 (control group). The use of ondansetron and chlorpheniramine was significantly decreased in group 1 and 2 when compared with group 3. Conclusion: This study concluded that Alizapride 100 mg, given intravenously immediately after clamping umbilical cord would reduce PONV and pruritus in parturients undergoing an elective cesarean section under spinal anesthesia.

Effectiveness of Alizapride for Prophylaxis of Nausea and Vomiting after Spinal Anesthesia for Cesarean Section

Background: Nausea and vomiting are common side effects in parturients undergoing cesarean delivery performed under spinal anesthesia can be very unpleasant to the patients. The reported incidence of nausea and vomiting during cesarean performed under regional anesthesia varies from 50% to 80% when no prophylactic antiemetic is given. Therefore, use of prophylactic antiemetics in parturients undergoing cesarean delivery is recommended by some authors. Objective: In this study, alizapride was evaluated, as a D2 receptor antagonist, on the prevention of nausea and vomiting following Spinal Anesthesiain parturients undergoing elective cesarean section. Patients and Methods: The study was carried out in AL-Azhar University Hospitals, Obstetric and gynaecology department on 90 patients undergoing an elective, lower segment cesarean section (LSCS). All patients were identified by code number to maintain the privacy of the patients. Any unexpected risks appeared during the course of the research was cleared to the participants and the ethical committee on time. A written informed consent was obtained from all patients. Patients were divided into 3 groups, 30 patients for each group. Group I (Alizapride 50 group): Received intravenous (IV) Alizapride 50 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group II (Alizapride 100 group): Received intravenous (IV) Alizapride 100 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group III (Saline group): Received normal saline 10 ml, immediately after clamping umbilical cord. Results: The incidence of nausea and vomiting was significantly decreased in group 2 (Alizapride100 group) compared with group 1 (Alizapride 50 group) and both group was better than group 3 (control group). The use of ondansetron and chlorpheniramine was significantly decreased in group 1 and 2 when compared with group 3. Conclusion: This study concluded that Alizapride 100 mg, given intravenously immediately after clamping umbilical cord would reduce PONV and pruritus in parturients undergoing an elective cesarean section under spinal anesthesia.

Prophylactic use of Parenteral Ketamine versus Ondansetron for Prevention of Shivering during Spinal Anesthesia in Hernia Surgeries

Background: Perioperative shivering is a common complication in modern anesthesia. It’s usually defined as readily detectable fasciculation or tremors of the face, jaw, head, trunk or extremities lasting longer than 15 seconds. Aim of the work: Compare the anti-shivering effect of parentral low dose ketamine and ondansetron after spinal anesthesia during hernia surgery, as well as the anticipated side effects and complications. Patients and Methods: This study presents a prospective randomized single blinded study. After obtaining approval from the medical ethical committee of Ain Shams University, this study was conducted in Ain Shams University hospitals operating rooms. Study period was from January 2018 to May 2018. Results: Our results indicated that low dose ketamine and ondansetron were effective, with more extent to ketamine, in prevention of post spinal shivering in patients undergoing hernia surgery and these results agreed with other results of studies done before. Conclusion: Our results indicated that Prophylactic low dose ketamine (0.25mg/kg) and Ondansetron (4mg) significantly decreased shivering in patients undergoing spinal anesthesia without significant side effects. Ketamine found to be more effective in controlling post spinal shivering.

Prophylactic use of Parenteral Ketamine versus Ondansetron for Prevention of Shivering during Spinal Anesthesia in Hernia Surgeries

Prophylactic use of Parenteral Ketamine versus Ondansetron for Prevention of Shivering during Spinal Anesthesia in Hernia Surgeries

Medical and Nursing Staff Education Reduces Use of Prophylactic Ondansetron With Opioids in the Emergency Department

IntroductionWe aimed to evaluate the effect of a pharmacist-led educational intervention on administration of ondansetron in patients receiving IV opioid analgesia in the emergency department. MethodsThis study is a retrospective chart review undertaken in a single-community emergency department. During October and November 2015, emergency medicine pharmacists completed an educational initiative targeting medical and nursing staff designed to reduce prophylactic administration of ondansetron. The multifaceted educational initiative comprised of a link to an animated video, posters at strategic locations in the department, e-mail reminders, brief presentations during shift change, and 1-on-1 discussion (see https://www.youtube.com/watch?v=Uvx8zKJBCCI). All patients who received IV morphine or hydromorphone during September and December 2015 were identified using pharmacy dispensing records, and 150 patients from each period were randomly selected for retrospective chart review. The primary outcome was the change in the proportion of prophylactic administration of ondansetron with IV opioids for acute pain in the emergency department. ResultsThe proportion of patients administered prophylactic ondansetron decreased from 41% in the preintervention period to 26% in the postintervention period (difference 95% confidence interval [CI] 4.8 to 25.9, P = 0.005). Therapeutic use for documented nausea or vomiting upon presentation decreased marginally from 44% to 35% (difference 95% CI –2.3 to 19.7, P = 0.1). An overall decrease in the incidence of administration of ondansetron from 85% to 61% was observed (difference 95% CI 14.4 to 33.6, P < 0.001). No patient required rescue antiemetic administration. ConclusionsMedical and nursing staff education yielded a significant reduction in the administration of prophylactic ondansetron for patients receiving IV opioids in the emergency department.

Ondansetron for Treatment of Nausea and Vomiting of Pregnancy and the Risk of Specific Birth Defects.

To use data from two large studies of birth defects to describe time trends in ondansetron use for the treatment of first-trimester nausea and vomiting of pregnancy and to investigate associations, either previously reported or undescribed, between first-trimester ondansetron use and major birth defects. We used data from two case-control studies, the National Birth Defects Prevention Study (1997-2011) and the Slone Birth Defects Study (1997-2014). The prevalence of ondansetron use for the treatment of first-trimester nausea and vomiting of pregnancy among control patients was calculated in 2-year intervals. Using women with untreated first-trimester nausea and vomiting of pregnancy as the reference, we calculated adjusted odds ratios (ORs) and 95% CIs for associations between first-trimester ondansetron use for treatment of nausea and vomiting of pregnancy and specific birth defects. A secondary exposure group of other prescription antiemetics was used to address confounding by indication. In the National Birth Defects Prevention Study and Slone Birth Defects Study, respectively, 6,751 and 5,873 control mothers and 14,667 and 8,533 case mothers who reported first-trimester nausea and vomiting of pregnancy were included in the analysis. Among women in the control group, ondansetron exposure increased from less than 1% before 2000 to 13% in 2013-2014. Ondansetron use was not associated with an increased risk for most of the 51 defect groups analyzed. Modest increases in risk were observed for cleft palate (adjusted OR 1.6, 95% CI 1.1-2.3) in the National Birth Defects Prevention Study and renal agenesis-dysgenesis (adjusted OR 1.8, 95% CI 1.1-3.0) in the Birth Defects Study, although these findings may be the result of chance. Off-label use of ondansetron for the treatment of nausea and vomiting of pregnancy increased to 13% by the end of the study period. For the majority of specific birth defects investigated, there was no increased risk associated with first-trimester use of ondansetron for treatment of nausea and vomiting of pregnancy compared with no treatment, although modest associations with cleft palate and renal agenesis-dysgenesis warrant further study.

Comparing the efficacy of intravenous ketorolac versus intravenous ibuprofen in relieving renal colic pain; a randomized clinical trial

Introduction: Various therapies have been used to relieve or improve the urinary colic pain, but many of these treatments have been limited due to side effects associated with the drugs. In this regard, opioid drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) have a higher priority than other treatments. Objectives: The aim of the present study was to compare the level of pain relief from renal stones after the administration of two types of NSAIDs, including intravenous ibuprofen versus intravenous ketorolac. Patients and Methods: In this clinical trial (identifier: IRCT20180108038276N1), 70 patients with renal colic pain were randomly treated with intravenous ketorolac (30 mg, n = 35) or with intravenous ibuprofen (800 mg, n = 35). The patient’s pain severity was assessed by the visual analogue scaling (VAS) method before and 20 and also 60 minutes after interventions. Results: Although pain severity considerably reduced within 60 minutes of prescribing ibuprofen and ketorolac, the trend of the change in pin score was not different between the two groups (P = 0.734). We found no significant difference in appearance of some side effects including nausea and vomiting, requiring use of ondansetron, need to prescribe additional analgesics. However epigastric pain and need to administrating H2 blockers were not revealed in the group receiving ketorolac, but these complications were found in 25.7% of the patients received ibuprofen indicating a significant difference (P = 0.002). Conclusion: A single dose administration of both intravenous ketorolac and ibuprofen is associated with significant improvement in renal colic pain within one hour after administration. However, due to the lower incidence of gastrointestinal complications in the administration of ketorolac compared to ibuprofen, the use of ketorolac in treatment and relief of renal colic pains is preferable.

Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy

Ondansetron is increasingly administered to children suffering from concussion-associated nausea/vomiting. We examined the association between ondansetron administration and post-concussion symptoms in children at 1 week and 1 month following the concussion. This was a secondary analysis of data collected prospectively in a cohort study conducted in nine pediatric emergency departments (EDs) (5P study). Participants were children ages between 5 and 17.99 years who sustained a concussion in the previous 48 hours. For the current study, only 5P participants who reported nausea and/or vomiting in the ED were eligible. The exposure of interest was ondansetron administration; the comparison group included all other participants. The primary outcome was an increase in at least three symptoms of the Post-Concussion Symptom Inventory score at 1 week and 1 month following trauma. Among the 3,063 children included in the 5P study, 1805 (59%) reported nausea and provided data at 1 week and/or 1 month. Among them, 132 (7%) received ondansetron. Multivariable logistic regression adjusted for confounders did not show an association between ondansetron use and the risk of persistent post-concussion symptoms at 1 week (OR: 1.13 [95% CI: 0.86-1.49]), but it was associated with a higher risk at 1 month (OR: 1.33 [95% CI: 1.05-1.97]). In children presenting to the ED with an acute concussion, ondansetron use was associated with a higher risk of persistent post-concussion symptoms at 1 month. Although this may be related to the limitations of the design, it highlights the importance of evaluating this association using a randomized clinical trial.

Nephrotoxicity Evaluation on Cisplatin Combined with 5-HT3 Receptor Antagonists: A Retrospective Study

Objective 5-HT3 receptor antagonist (ondansetron) has been reported to have nephrotoxic effect when combined with cisplatin in mice; however, little evidence exists in explaining its nephrotoxic effects on patients. The aim of this present study was to investigate whether 5-HT3 receptor antagonist could enhance or aggravate the incidence of cisplatin-induced nephrotoxicity in patients. Methods We retrospectively reviewed 600 tumor patients which were treated with cisplatin (⩾60 mg/m2) as a first-time chemotherapy and combined with 5-HT3 receptor antagonist (i.e., ondansetron, tropisetron, or ramosetron, each kind of 5-HT3 receptor antagonist contains 200 cases) between January 2010 and December 2015. Cisplatin dosing, the baseline creatinine clearance, and other independent risk factors such as patient's age, sex, PS score, and weight associated with nephrotoxicity were evaluated in a multivariable model. Results The incidence of Grade ⩾ 2 serum creatinine elevation in cisplatin + ondansetron group was significantly higher than cisplatin + tropisetron group (P = 0.04), but no significant difference was found between cisplatin + ondansetron group and cisplatin + ramosetron group (P = 0.3). It was also found that cisplatin dosage and tumor type were independent risk factors in the development of nephrotoxicity. Conclusion Higher cisplatin dosage and regular use of ondansetron combined with cisplatin are more likely to increase the incidence of nephrotoxicity; tropisetron showed the relatively mild effect on kidney function, suggesting that tropisetron is a preferable alternative in the process of cisplatin chemotherapy.

The Use of a Triage-Based Protocol for Oral Rehydration in a Pediatric Emergency Department.

Guidelines recommend oral rehydration therapy (ORT) and avoidance of laboratory tests and intravenous fluids for mild to moderate dehydration in children with gastroenteritis; oral ondansetron has been shown to be an effective adjunct. The aim of this study was to determine if a triage-based, nurse-initiated protocol for early provision of ondansetron and ORT could safely improve the care of pediatric emergency department (ED) patients with symptoms of gastroenteritis. This study evaluated a protocol prompting triage nurses to assess dehydration in gastroenteritis patients and initiate ondansetron and ORT if indicated. Otherwise well patients aged 6 months to 5 years with symptoms of gastroenteritis were eligible. Prospective postintervention data were compared with retrospective, preintervention control subjects. One hundred twenty-eight (81 postintervention and 47 preintervention) patients were analyzed; average age was 2.1 years. Ondansetron use increased from 36% to 75% (P < 0.001). Time to ondansetron decreased from 60 minutes to 30 minutes (P = 0.004). Documented ORT increased from 51% to 100% (P < 0.001). Blood testing decreased from 37% to 21% (P = 0.007); intravenous fluid decreased from 23% to 9% (P = 0.03). Fifty-two percent of postintervention patients were discharged with prescriptions for ondansetron. There were no significant changes in ED length of stay, admissions, or unscheduled return to care. A triage nurse-initiated protocol for early use of oral ondansetron and ORT in children with evidence of gastroenteritis is associated with increased and earlier use of ondansetron and ORT and decreased use of IV fluids and blood testing without lengthening ED stays or increasing rates of admission or unscheduled return to care.

Abstract P6-11-18: Ten year trends in antiemetic prescribing in cancer patients receiving highly emetogenic chemotherapy (HEC)

Abstract Purpose: Prevention of chemotherapy-induced nausea and vomiting (CINV) is essential to preserve quality of life in cancer patients receiving highly emetogenic chemotherapy (HEC) such as doxorubicin-cyclophosphamide (AC) or cisplatin. Recently, new drugs (e.g. fosaprepitant and newer neurokinin 1 receptor antagonists [NK1RAs], rolapitant and netupitant) and updated guidelines for antiemetic use (e.g. adding olanzapine) have emerged. However, trends in real world antiemetic use are understudied. Methods: We performed a retrospective study using the OptumLabs Data Warehouse (OLDW), which includes administrative claims for privately insured and Medicare Advantage enrollees in the U.S. We identified 34,236 patients age 18 years or older treated with either AC or cisplatin between January 2006 and June 2016. Data collected included baseline demographics (age, gender, census region and race), chemotherapy administered, and presence/absence of a central intravenous access device. Trends of anti-emetic use were presented overall and separately for 5-HT receptor antagonists (5HT3RAs) and NK1RAs. Results: 23,030 patients (67.3%) received an anthracycline-based regimen (AC with or without docetaxel or paclitaxel), and 11,206 (32.7%) patients received cisplatin. Approximately two thirds of patients were female (n= 23,392). Dexamethasone use was stable over the decade (used by 85-90% in all years). Use of 5HT3RAs, primarily palonosetron and ondansetron, occurred in at least 95% of patients in all study years, consistent with guideline recommendations. NK1RAs were underutilized early on compared with guideline recommendations, but use increased to approximately 80% in the most recently evaluated year. Fosaprepitant use rose precipitously starting in 2009, preceding a sharp fall in aprepitant use beginning in 2011. The use of olanzapine, rolapitant and netupitant was minimal throughout the study period. Conclusions: Dexamethasone and 5-HT3RAs were used in the vast majority of patients receiving HEC, in accordance with guideline recommendations. Less compliance with guidelines was seen with NK1RA use. Citation Format: O'Sullivan CC, Van Houten HK, Sangaralingham L, Leal AD, Shinde S, Liu H, Ettinger D, Loprinzi CL, Ruddy KJ. Ten year trends in antiemetic prescribing in cancer patients receiving highly emetogenic chemotherapy (HEC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-18.

A nurse-driven protocol for oral rehydration therapy in mildly dehydrated pediatric patients

A nurse-driven protocol for oral rehydration therapy in mildly dehydrated pediatric patients

ИНТРАОПЕРАЦИОННАЯ СТИМУЛЯЦИЯ СРЕДИННОГО НЕРВА СНИЖАЕТ РИСК ПОСЛЕОПЕРАЦИОННОЙ ТОШНОТЫ И РВОТЫ ПОСЛЕ УДАЛЕНИЯ ОПУХОЛИ ЗАДНЕЙ ЧЕРЕПНОЙ ЯМКИ

The article presents the results of a prospective randomized double-blind study which was investigating the efficacy of intra-operative transcutaneous stimulation of median nerve on the wrist aimed to prevent post-operative nausea and vomiting after planned resection of brain tumors located in posterior fossa. Methods. 40 patients were included into the study: 20 patients were enrolled into the stimulation group and 20 of them were enrolled into the control group, where the prevention of emetogenic reactions was limited by the use of dexamethasone and ondansetron. Results. The demographic and clinical parameters were compatible in the both groups. During the first 12 hours after recovery, the risk to develop symptoms was significantly lower in the stimulation group (p <0.05): 7 cases versus 14 ones in the control group (RR =0.5; 95% CI 0.26−0.97) and 4 versus 10 cases of vomiting in the control group (RR =0.4; 95% CI 0.15−1.07). No side effects were observed. Conclusion. It was confirmed that this method was effective to prevent postoperative nausea and vomiting in the patients who underwent infratentorial craniotomy.

Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron

Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. In this randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I and II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software. The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions. Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.

Ondansetron Prescription for Home Use in a Pediatric Emergency Department.

Ondansetron has been shown to decrease admission rate and the need for intravenous fluids among pediatric emergency department (ED) patients with acute gastroenteritis, but there is limited evidence regarding its use after ED discharge. This study describes prescribing patterns for ondansetron and assesses the effects of ondansetron home prescription on rate of return. Data were gathered from the electronic health record on 2 separate but overlapping groups of patients seen in a pediatric ED from 2012 to 2014. The Gastroenteritis Group included all patients with a discharge diagnosis of gastroenteritis by International Classification of Diseases, Ninth Revision, code. The All Ondansetron Group included any child prescribed ondansetron at discharge. Patterns of ondansetron use and 3- and 7-day ED return rate were assessed for both groups. Discharge diagnosis was evaluated for the All Ondansetron Group. A total of 996 patients with acute gastroenteritis were identified during the study period. Of these, 76% received ondansetron in the ED, and 71% were discharged with prescriptions for ondansetron. Seven-day ED return rates were similar between groups (6% with prescription, 5% without, P = 0.66). A total of 2287 patients received home prescriptions for ondansetron. Fifty-four percent of these patients' discharge diagnoses were classed as gastrointestinal complaints, 14% other infectious conditions, 9% respiratory, and 4% injuries. Their return rate was 6%. There was wide variation in the number of doses prescribed. Home-use ondansetron is widely prescribed in this urban academic pediatric ED for a variety of indications, without effect on 3- or 7-day ED return. Further prospective studies are necessary to determine the efficacy of this practice.

Use of Ondansetron for Vomiting After Head Trauma: Does It Mask Clinically Significant Traumatic Brain Injury?

We describe ondansetron use in children with head injury evaluated in pediatric emergency departments and its association with return visits and late diagnoses of intracranial injuries requiring intervention. Children ages 6 months to 18 years discharged without neuroimaging from 35 pediatric emergency departments with a diagnosis of head injury from 2009 to 2013 were identified retrospectively from the Pediatric Health Information System. We evaluated the rates of ondansetron use during the study period and of the association of ondansetron treatment with the diagnosis of intracranial injury, skull fracture, and return visits within 72 hours requiring admission or operative intervention. We identified 218,904 encounters during the study period. Of these, 5894 patients (2.8%) were given ondansetron. There was significant variation in the use of ondansetron during the index visit between hospitals (0.1%-5.7%), and ondansetron use significantly increased over the study period. Return visits within 72 hours were more likely for patients treated with ondansetron during the index visit (3.7% vs 1.9%; adjusted odds ratio, 1.99; 95% confidence interval, 1.7-2.4). These patients were more likely to be admitted than those not treated initially with ondansetron (7% vs 4%; adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.55). There were no significant differences in rates of skull fractures, intracranial injury, intensive care unit admission, or operative intervention between groups. Ondansetron use during an initial emergency department visit for head trauma in children not requiring neuroimaging is associated with a higher likelihood of return within 72 hours and subsequent admission. There were no differences in rates of missed skull fractures, intracranial injury, intensive care admission, or operative intervention for groups who were and were not treated with ondansetron; however, this study was underpowered to detect significant differences in these categories. Future investigations with greater numbers would be required to confidently assess these critical differences.