Severity Of Nausea Research Articles

Comparison of Three Different Doses of Dexamethasone Added to Midazolam for Prophylaxis against Nausea and Vomiting after Laparoscopic Cholecystectomy during Early Postoperative Period

Abstract Background General anesthesia using volatile anesthetics is associated with high incidence of postoperative nausea and vomiting ranging between 20% - 30% within 24 hours after surgery. Postoperative nausea and vomiting is thought to be of multifactorial etiology involving anesthetics, surgical and individual factors. Objective To compare between three different doses of Dexamethasone in conjunction with predetermined fixed dose of Midazolam which can provide effective prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy. Patients and Methods 1ry outcome was to decrease nausea and vomiting after laparoscopic cholecystectomy and 2ry outcome was itching and dizziness. The present study was conducted in Ain shams University hospitals on 120 adult female patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled to an elective laparoscopic cholecystectomy. After obtaining approval from the research ethical committee of faculty of medicine of Ain Shams University, a written informed consent was obtained from every patient after explaining the procedure. Results Over 24 h, the incidence of nausea, vomiting and rescue antiemtic use reduced significantly in Group ІІ and Group ІІІ when compared to group І. As with incidence, the severity of nausea was even significantly reduced in the group ІІ and group ІІІ group (P 0.043 and 0.009) respectively compared to group І in 24 hours postoperative. Postoperative pain was assessed for initial 6 h. Group ІІ and group ІІІ had significant reduction in severity of pain (P < 0.016 and 0.006) respectively when compared to group І while there was no significant difference between group ІІ and group ІІІ. Moreover, the incidence of use of rescue analgesia significantly reduced from 82.5% in group І to 52.5% and 45% in group ІІ and group ІІІ, respectively. However, dose of rescue analgesia used in 6 h was significantly reduced in Group ІІІ only (P = 0.013). Conclusion The minimum effective dose for prevention of postoperative nausea is 4 mg of Dexamethasone in combination with Midazolam in female patients undergoing Laparoscopic cholecystectomy with additional advantage of analgesia in the early postoperative period. Further reduction in incidence and severity of PONV can be achieved with a dose of 8 mg dexamethasone.

Evaluation of the Role of Preoperative Oral Amisulpride as Part of a Multimodal Antiemetic Prophylaxis Regime on Postoperative Nausea and Vomiting in Patients Undergoing Craniotomy: A Prospective, Double-Blind, Randomized, Placebo-controlled Study.

Patients undergoing craniotomy are at high risk for postoperative nausea and vomiting (PONV) despite the use of prophylactic antiemetics. We hypothesized that a single preoperative oral dose of amisulpride as part of a multimodal antiemetic regimen would decrease the incidence of PONV in patients undergoing craniotomy for intracranial tumor surgery. Adult patients scheduled for elective craniotomy requiring general anesthesia were enrolled and randomized to receive either oral amisulpride 25mg or placebo 2 hours before surgery in addition to our institution's usual antiemetic regimen. The primary outcome of the study was the incidence of nausea and/or vomiting during the first 24 hours postoperatively. Secondary outcomes included severity of nausea, use of rescue antiemetic medications, and treatment-related adverse events. A total of 100 patients were included in the analysis. More patients in the amisulpride group had no episodes of nausea (90% vs. 40%; P<0.001) and no episodes of vomiting (94% vs. 46%; P<0.001) compared with the placebo group. The severity of nausea was lower in the amisulpride group than in the control group in the first 4 hours after surgery (P<0.05), and fewer patients receiving amisulpride required rescue antiemetics (P<0.001). The incidence of treatment-related adverse events was similar between groups. A single preoperative oral dose of amisulpride 25mg as a component of a multimodal antiemetic regimen decreased the incidence and severity of PONV in patients undergoing craniotomy for intracranial tumor surgery, with no adverse effects.

An Evidence-Based Practice Project to Determine Ginger's Effect on Nausea and Vomiting in Pregnant Women During the Antepartum Period

Nausea and vomiting is an ailment that accompanies pregnancy and affects up to 80% of pregnant women. A decrease in quality of life and feelings of depression have been associated with nausea and vomiting of pregnancy (NVP). This evidence-based practice project aims to evaluate the effect of ginger on nausea and vomiting in pregnant women during the antepartum period compared to not using ginger. Articles addressing the impact of ginger on nausea and vomiting in pregnant women were searched and identified in four databases: PubMed/MEDLINE, Cumulative Index to Nursing and Allied Literature (CINHAL), ProQuest, and Cochrane (Reviews). The Johns Hopkins Evidence-based Practice Model Appraisal tools were utilized to thoroughly examine and assess the strength and quality of each article. Six articles were included in this evidence-based practice project. The results demonstrated that the use of ginger versus placebo significantly reduced the severity of nausea, but was less effective at reducing vomiting. Ginger was found to be either as effective as vitamin B6 or less effective. Ginger alleviated NVP when compared with placebo. Further research is required to determine whether vitamin B6 or ginger is more effective and to establish the best method of ginger intake. Overall, ginger is an affordable natural remedy that nurses can recommend to pregnant patients experiencing NVP.

Remimazolam's Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial.

(1) Background: Remimazolam is a novel benzodiazepine that prevents postoperative nausea and vomiting (PONV), is more effective than volatile anesthetics, and was recently approved for use in Japan. (2) Methods: This prospective, double-blind, randomized controlled trial study aimed to compare the efficacy of remimazolam and propofol as general anesthetics in terms of the incidence of PONV after laparoscopic gynecological surgery (UMIN000046237). High-risk female patients who underwent general anesthesia with either remimazolam or propofol for the maintenance of anesthesia were enrolled. The primary outcome was the incidence of PONV in the two groups (i.e., REM versus PROP) 2 h and 24 h after surgery. The incidence of vomiting without nausea, rescue antiemetic use, and the severity of nausea were also evaluated. (3) Results: No significant differences in PONV were identified between the REM and PROP groups at 2 h or 24 h. Furthermore, no differences were observed in any of the measured parameters, and no adverse events were reported. (4) Conclusions: The results of the present study suggest that remimazolam may be as effective as propofol in preventing PONV; however, further investigation is necessary to identify possible differences between these two agents.

Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia—Integrating a Behavioral Intervention

ObjectivesFunctional dyspepsia (FD) includes postprandial distress and epigastric pain syndrome. Percutaneous electrical nerve field stimulation (PENFS) in addition to behavioral interventions (BI) has shown benefits in children with functional abdominal pain but not specifically in FD. We aimed to assess the efficacy of PENFS for treating FD and compare the outcomes with those who received the combination of PENFS + BI. Materials and MethodsCharts of patients with FD who completed four weeks of PENFS were evaluated. A subset of patients received concurrent BI. Demographic data, medical history, and symptoms were documented. Outcomes at different time points included subjective symptom responses and validated questionnaires collected clinically (Abdominal Pain Index [API], Nausea Severity Scale [NSS], Functional Disability Inventory [FDI], Pittsburgh Sleep Quality Index [PSQI], Children’s Somatic Symptoms Inventory [CSSI], Patient-Reported Outcomes Measurement Information Systems [PROMIS] Pediatric Anxiety and Depression scales). ResultOf 84 patients, 61% received PENFS + BI, and 39% received PENFS alone. In the entire cohort, API (p < 0.0001), NSS (p = 0.001), FDI (p = 0.001), CSSI (p < 0.0001), PSQI (p = 0.01), PROMIS anxiety (p = 0.02), and depression (p = 0.01) scores improved from baseline to three weeks and at three months. Subjective responses showed nausea improvement (p = 0.01) and a trend for improvement in abdominal pain (p = 0.07) at week three. Abdominal pain subjectively improved at week three and three months (p = 0.003 and 0.02, respectively), nausea at week three and three months (p = 0.01 and 0.04, respectively), and a trend for improvement in sleep disturbances at week three and three months (p = 0.08 and p = 0.07, respectively) in the PENFS + BI group vs PENFS alone. ConclusionAbdominal pain, nausea, functioning, somatization, sleep disturbances, anxiety, and depression improved at three weeks and three months after PENFS in pediatric FD. Subjective pain and nausea improvement were greater in the PENFS + BI group than in the group with PENFS alone, suggesting an additive effect of psychologic therapy.

Gastric electrical stimulation is safe during pregnancy and delivery: Results from a French cohort.

Gastric electrical stimulation (GES) is an effective therapy in medically refractory chronic nausea and vomiting. GES is assumed to be a contraindication for pregnancy. We examined the safety of GES during pregnancy and its clinical impact on vomiting symptoms. A retrospective study was performed in two tertiary centers including all female patients of childbearing age implanted with GES. Patients without pregnancy while on GES were asked about their desire and concerns about pregnancy. Patients who were pregnant while on GES therapy were interviewed about the course of the pregnancy and labor, as well as the health of the children. Among 91 patients implanted at childbearing age, 54 patients without pregnancy answered the questionnaire. Nine patients (16.7%) reported a desire for pregnancy and five patients (7.4%) reported worries about the safety of GES during pregnancy. Sixteen pregnancies were reported in 10 patients. All pregnancies ended in a live birth with premature birth in 12 pregnancies (75.0%). No health concern was currently noted in these children. No severe GES-related complications occurred during pregnancy with only pain at the implantation site reported during 3 pregnancies (18.8%). The severity and frequency of nausea and vomiting significantly increased during the first trimester (p = 0.04 and p = 0.005, respectively) and decreased after the delivery, becoming lower than before the pregnancy (p = 0.044 and p = 0.011, respectively). Patients are concerned regarding pregnancy while being treated with GES. No serious maternal or fetal complications related to GES were noted in our cohort.

Effects of the Wrist Band Acupressure Technique on the Severity of Nausea among Patients Receiving Highly Versus Moderately Emetogenic Chemotherapy

Background: Chemotherapy is an important therapeutic option for patients with cancers, but it is also associated with a number of adverse effects that can affect practically every body system. The most frequent side effects of chemotherapy are gastrointestinal in nature, such as nausea and vomiting. The pericardium 6 (P6) is one of the most important points used in acupressure techniques for treating nausea and vomiting.&#x0D; Aim: This study aims to examine the effects of wrist band acupressure technique on the severity of nausea among patients receiving highly or moderately emetogenic chemotherapy.&#x0D; Methods &amp; materials: A quasi-experimental design was conducted at the Imam Al-Hussein Center for Oncology and Hematology and the oncology wards of the Imam Al-Hassan Al-Mujtaba teaching hospital, which is located in Kerbala Holy City. Forty-seven patients with cancer undergoing chemotherapy were divided into two groups: 22 patients were assigned in the intervention group and 25 in the control group. Patients in the intervention group were followed to perform acupressure techniques, while in the control group only received routine conventional care.&#x0D; Results: Before applying the interventional approach, the intervention group's overall mean score for nausea was 52.3±10.9; it was 39.8 ±14.5 after implementing the intervention. There is a statistically significant difference in the severity of nausea between the two groups after implementing the interventional protocol at a p-value of 0.000. Moreover, there are no significant differences between the severity of nausea after using wrist band acupressure and the type of chemotherapy (p-value 0.6).&#x0D; Conclusion: Using wrist band acupressure as a noninvasive technique can be effective in reducing the severity of nausea among patients receiving highly or moderately emetogenic chemotherapy.&#x0D;

The role of NEPA, a combination of netupitant and palonosetron, in the prevention of nausea and vomiting: case report and literature review

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common complications of the systemic anticancer treatment. The manifestations of this complication are largely determined by subjective perceptions and individual characteristics of patients, but this complication may have unprecedented negative impact on the quality of life of cancer patients. There were significant advances in CINV prophylaxis in the recent decades, with many effective antiemetic drugs entering routine clinical practice. Current clinical guidelines for antiemetic therapy provide various possible strategies for CINV prevention, but do not give any specific guidance on the selection of individual agents within each class of emetogenic potential. NEPA, which is a fixed-dose combination of NK1-antagonist netupitant and 5-HT3 antagonist palonosteron, is the most recent antiemetic drug in clinical practice. This article reviews current data on the effectiveness of this drug and aims to define its “niche” in antiemetic therapy. The results of historical and most relevant studies demonstrating the effectiveness of NEPA in CINV prevention, pharmacological features of the drug and its potential advantages are discussed. The role of the drug in the existing therapeutic arsenal was evaluated using the example of a clinical report of treatment of a patient with an aggravated history (type 2 diabetes mellitus with poorly controlled hyperglycaemia) The patient achieved a complete response to the antiemetic therapy: no episodes of vomiting during treatment, the severity of nausea did not exceed the 1st grade, no additional prescription of antiemetic drugs was required.

The evidence bases of etiopathophysiology and preventive clinical management of nausea and vomiting in pregnancy

Nausea and vomiting, or early toxicosis, is a common disorder during pregnancy, affecting up to 80% of pregnant women. The severe form is known as excessive vomiting of pregnancy – hyperemesis gravidarum (HG) and is a debilitating and potentially life-threatening illness during pregnancy which is characterized by persistent nausea and/or vomiting, weight loss, malnutrition and dehydration, increases the risk of adverse maternal and perinatal outcomes.Without the methodical intervention of experienced clinicians, life-threatening complications can develop. Effective prevention and treatment strategies for HG require an understanding of both pathophysiological and psychosocial factors, awareness of potential risks and complications, and proactive assessment and treatment methods using innovative clinical tools. HG is characterized by dehydration, electrolyte and metabolic imbalance, as well as nutritional deficiency, which can lead to hospitalization. The severity of nausea and vomiting during pregnancy can be assessed using the Unique Gestational Vomiting Qualification (scale PUQE-24), which has been shown to be a relatively accurate assessment of the patient’s lifestyle, including hours of sleep.For high-quality differential diagnosis, a focused anamnesis collection and examination are necessary, since the diagnosis of this condition is mainly determined clinically. Laboratory tests are useful tools for evaluating complications such as electrolyte or metabolic imbalances or kidney damage. In addition, they help to determine the etiology in refractory cases.Hypotheses that contribute to the understanding of the pathogenesis of HG have been based on associations that are causal, sequential, or coincidental. Much efforts are needed to precisely establish these relationships in well-designed studies. HG is the most common indication for hospitalization in the first half of pregnancy. Numerous nutrient deficiencies have been identified, such as thiamine deficiency, which can lead to Wernicke’s encephalopathy, vitamin K deficiency, and severe hypokalemia.It is noteworthy that, in addition to the above-mentioned physical complications, HG is also associated with psychological adverse consequences. Although it has been associated with serious complications, little is known about its prognostic factors.The purpose of this systematic review was to find and critically evaluate studies that determined the priority areas of clinical management of vomiting in pregnant women, based on the differentiation and pathophysiological component, the analysis of the safety profile of non-pharmacological agents to prevent the development of the above-mentioned gestational pathology, and the clarification of an effective strategy of interprofessional teams to improve care coordination and outcomes in pregnant women with nausea and vomiting.A systematic data search was carried out in the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects and publications in professional publications of Ukraine for 2010–2023.The main result was the prediction of the occurrence of vomiting in pregnant women and HG, the effectiveness of preventive intervention, the reduction or cessation of nausea/vomiting; the number of episodes of vomiting; duration of hospitalization. Secondary outcomes included other parameters of preventive strategy effectiveness, adverse maternal/fetal/neonatal outcomes, quality of life measures, and economic costs. Preventive measures: ginger, acupressure/acupuncture, diet, hypnotherapy. The economic evaluation of prevention strategies also took into account perinatal outcomes. Therapeutic strategies, primarily infusion therapy, will be reviewed and analyzed by us in the following review.The results of evidence-based medicine presented in the reviews can be used in the creation of a clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of nausea, vomiting of pregnancy and HG.

The effect of lemon inhalation aromatherapy on pain, nausea, as well as vomiting and neurovascular assessment in patients for lower extremity fracture surgery: a randomized trial

BackgroundComplementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery.MethodsThis is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA.ResultsA significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03).ConclusionsThis study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery.Trial registrationThis study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) (https://www.irct.ir/trial/57331).

Effects of menthol gum chewing on postoperative nausea, vomiting, and length of hospital stay in children undergoing appendectomy: A randomized controlled trıal

PurposeThis study aimed to determine the effects of menthol gum chewing on nausea, vomiting, and length of hospital stay after appendectomy in children. BackgroundPostoperative nausea and vomiting (PONV) can be induced by general anesthesia. Several drugs are available to reduce the risk of PONV; however, their cost and side effects limit their clinical use. MethodThis was a randomized controlled clinical trial that included 60 children aged 7–18 years who underwent an appendectomy at the Pediatric Surgery Clinic of a tertiary hospital between April and June 2022. Data for this study were collected via the developed information form, which included participants' descriptive characteristics and bowel function parameters, and the Baxter Retching Faces (BARF) nausea scale. Children in the study group who underwent an appendectomy were given chewing gum and asked to chew it for an average of 15 min, whereas those in the control group received no intervention. ResultsThe BARF nausea score measured during the menthol gum chewing period was lower in the study group, and the difference score value calculated after pretest time was higher in the study group, as expected (p < 0.001). Moreover, menthol gum chewing was found to shorten hospital stay by 1 day (p < 0.05). ConclusionMenthol gum chewing reduced the severity of postoperative nausea and length of hospital stay. Practice implicationChewing gum can be used as a nonpharmacological method by pediatric nurses in clinical practice to reduce the severity of postoperative nausea and length of hospital stay.

Effectiveness of Palonosetron, 1-Day Dexamethasone, and Aprepitant in Patients Undergoing Carboplatin-Based Chemotherapy

Introduction: Dexamethasone (DEX)-sparing strategy with 5-hydroxytryptamine-3 receptor antagonist (5HT₃RA) and aprepitant (APR), as triplet antiemetic prophylaxis, is associated with poor control of delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving carboplatin (CBDCA)-based chemotherapy. This study aimed to evaluate whether using palonosetron (PALO) as a 5HT₃RA provides superior control with CINV than first-generation (1st) 5HT₃RA in triplet antiemetic prophylaxis with a DEX-sparing strategy. Methods: Pooled patient-level data from a nationwide, multicenter, and prospective observational study were analyzed to compare the incidence of CINV between patients administered PALO and 1st 5HT₃RA in combination with 1-day DEX and APR. Results: No significant differences were observed in the incidence of CINV, pattern of CINV, or severity of nausea by type of 5HT₃RA in triplet antiemetic prophylaxis with DEX-sparing strategy. In both groups, the incidence of nausea gradually increased from day 3, peaked on day 4 or 5, and then declined slowly. The visual analog scale scores in the delayed phase remained high throughout the 7-day observation period. Conclusion: Careful patient selection and symptom monitoring are needed when implementing the DEX-sparing strategy in triplet antiemetic prophylaxis for patients undergoing CBDCA-based chemotherapy. Furthermore, additional strategies may be needed to achieve better control of delayed CINV.

Patient- versus clinician-reported symptoms in the POLARIX study.

12100 Background: The safety profiles of novel agents are mainly based on clinician-reported adverse events (AEs) from clinical trials. Patient-reported outcomes (PROs) may better represent the treatment burden experienced by patients (pts) compared with clinician-reported AEs. Using data from POLARIX, a double-blind, placebo-controlled, randomized Phase 3 international study (NCT03274492), we previously presented PRO and clinician-reported data showing similar rates of neuropathy (Trněný et al. 2022). Here, we evaluate the reporting of other common symptoms using PRO and clinician-reported data in POLARIX. Methods: POLARIX methods were previously described (Tilly et al. 2022); this analysis included all pts with PRO data. PRO and clinician-reported data described the incidence and severity of fatigue, constipation, diarrhea, nausea, and vomiting. Clinician-reported severity grading was based on the NCI Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.0. PROs were collected using the European Organisation Research and Treatment of Cancer Quality of Life-Core 30 questionnaire (EORTC QLQ-C30), which was administered to pts at clinic visits on Day 1 of Cycles 1 (baseline), 2, 3, and 5, and end of treatment (EOT). PRO severity scores included ‘A little’, ‘Quite a bit’, and ‘Very much’. Results: Overall, 825 pts were evaluable. From baseline to EOT, PROs showed a higher incidence of symptoms compared with clinicians for fatigue (98% vs 27%), constipation (68% vs 29%), diarrhea (56% vs 26%), nausea (58% vs 40%), and vomiting (24% vs 15%). PRO severity scores of ‘Quite a bit’ or ‘Very much’ were reported in 33% of pts for fatigue, 29% for constipation, 17% for diarrhea, 19% for nausea, and 7% for vomiting. Clinicians reported Grade ≥2 symptoms in 11% of pts for fatigue, 11% for constipation, 11% for diarrhea, 14% for nausea, and 6% for vomiting. Conclusions: In POLARIX, pts reported a higher incidence and severity of symptoms compared with clinicians. Although distinct scales were used, the differences in symptom rates reported by pts and clinicians were clinically meaningful. These data may have implications for symptom management, including physician evaluation and communication of symptom expectations for pts. Reporting of symptoms by PROs should be incorporated into clinical trials as an adjunct to standard AE reporting to better characterize the patient experience. Clinical trial information: NCT03274492 . [Table: see text]

Effect of Supportive Counseling Using a Positive Psychology Approach on Improving the Severity of Nausea and Vomiting in Pregnant Women: A Randomized Controlled Trial

Effect of Supportive Counseling Using a Positive Psychology Approach on Improving the Severity of Nausea and Vomiting in Pregnant Women: A Randomized Controlled Trial

Effectiveness of NEPA, an oral fixed-dose combination of netupitant and palonosetron in the prevention of chemotherapy induce nausea (CIN): A post-hoc analysis.

e24140 Background: Despite widespread use of antiemetics, chemotherapy-induced nausea is still reported by upto 70% of adult patients receiving moderately emetogenic chemotherapy(MEC) or highly emetogenic chemotherapy (HEC) agents. Control of nausea remains an important, unmet need among cancer patients. The current evidence suggests that, overall, no significant nausea is reported by upto 75% of the patients with the aprepitant based regimens. Here, we present a post-hoc analysis of an observational study on NEPA (NEtupitant 300mg and PAlonosetron 0.50 mg) in preventing nausea in patients receiving HEC/MEC in a real-world setting in India. Methods: An open-label, single-arm, prospective study among chemonaive patients was conducted across six centers from April 2019 to December 2021 after approval from each institutional ethics committee (CTRI/2020/02/023586). A post-hoc analysis was carried out to assess the effectiveness of NEPA in preventing CIN in patients. The parameters assessed included severity of nausea using a visual analogue scale (VAS) [No significant nausea (includes no/mild nausea) &lt; 2.5cm on VAS scale, moderate nausea 2.5cm to 7.5cm, Severe nausea 7.5cm to 10cm], complete control (no nausea and complete response) and safety. Results: Of the 354 patients, 289 (81.64%) received the HEC regimen, and the remaining 65 (18.36%) received the MEC regimen. Anthracycline-Cyclophosphamide (36.16%) and FOLFOX (6.21%) were the most common HEC and MEC regimens, respectively. In the overall, acute, and delayed phases, no significant nausea was reported in 89.83%., 93.22% and 92.65% of the patients, respectively. Moderate and severe nausea was reported in 5.65%, and 1.13% of patients in the acute phase, 5.65%, and 1.69% in the delayed phase, and 8.19%, and 1.98% in the overall phase respectively. Among, those on HEC and MEC regimen, no significant nausea was reported in 93.42 % and 89.23 % respectively during the overall phase (Table 1). Complete control was achieved in 77.40% of patients in the overall phase, 82.77% in the acute phase, and 85.03% in the delayed phase. Adverse events were reported in 10 (3.4%) patients, with leg pain being the most common 3(0.8%). Conclusions: NEPA was found to be effective and well tolerated in preventing nausea in patients receiving HEC/MEC regimens, with almost 90% of patients reporting no significant nausea in real world Indian setting. Clinical trial information: CTRI/2020/02/023586 .[Table: see text]

Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis

BackgroundPostoperative nausea and vomiting (PONV) is a common but troublesome complication in patients who undergo laparoscopic bariatric surgery (LBS). Whether sugammadex use is related to the persistent decrease in the occurrence of PONV during postoperative inpatient hospitalization, which is critical for the rehabilitation of patients after LBS, remains unknown.MethodsThe study was based on a randomized controlled trial conducted in an accredited bariatric centre. A total of 205 patients who underwent LBS were included in the analysis. Univariate analysis and multivariable logistic regression model were used to identify the significant variables related to PONV. Then propensity score matching and inverse probability of treatment weighting (IPTW) were employed to compare outcomes between the sugammadex and neostigmine groups. The primary outcome was the incidence of PONV within 48 h after LBS. The secondary endpoints included the severity of PONV, time to first flatus, need for rescue antiemetic therapy, and water intake.ResultsThe incidence of PONV was 43.4% (89/205) within the first 48 h after LBS. In multivariable analysis, sugammadex use (OR 0.03, 95% CI 0.01–0.09, P < 0.001) was an independent protective factor of PONV. After IPTW adjustment, sugammadex use was associated with lower incidence of PONV (OR 0.54, 95% CI 0.48–0.61, P < 0.001), postoperative nausea (PON) (OR 0.77, 95% CI 0.67–0.88, P < 0.001), and postoperative vomiting (POV) (OR 0.60, 95% CI 0.53–0.68, P < 0.001) within postoperative 48 h. The severity of PON as well as the incidence and severity of POV within the first 24 h were also lower in the sugammadex group (all P < 0.05). Reduced need for rescue antiemetic therapy within the first 24 h, increased water intake for both periods, and earlier first passage of flatus were observed in the sugammadex group (all P < 0.05).ConclusionsCompared with neostigmine, sugammadex can reduce the incidence and severity of PONV, increase postoperative water intake, and shorten the time to first flatus in bariatric patients during postoperative inpatient hospitalization, which may play a pivotal role in enhanced recovery.Trial registrationChinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893, date of registration: October 25, 2021).

Effects of gluten on dyspeptic symptoms: a systematic review and meta-analysis of clinical trials.

Research on the effects of gluten on dyspeptic symptoms has shown conflicting results. The aim of this systematic review and meta-analysis of clinical trials was to assess the effects of gluten on dyspeptic symptoms. A systematic search of the PubMed, ISI Web of Science, Scopus, Cochrane, and Embase online databases was performed up to May 2022. Randomized controlled trials (RCTs) and non-RCTs that examined the impact of a gluten-free diet, a low-gluten diet, or a gluten challenge on dyspeptic symptoms, including early satiety, epigastric pain, bloating, and nausea, were selected independently by 2 authors. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of the evidence. Results were pooled using a random-effects model and expressed as weighted mean differences (WMDs) and 95%CIs. Of the 7641 citations retrieved, 27 articles (18 RCTs and 9 non-RCTs) were included in the systematic review. Of those, 5 RCTs were eligible for the meta-analysis. The pooled results indicated that gluten challenge significantly increased the severity of bloating (WMD = 0.67; 95%CI, 0.37-0.97; I2 = 81.8%; n = 6), early satiety (WMD = 0.91; 95%CI, 0.58-1.23; I2 = 27.2%; n = 5), and epigastric pain (WMD = 0.46; 95%CI, 0.17-0.75; I2 = 65.8%; n = 6). However, the effect of gluten challenge on the severity of nausea (WMD = 0.13; 95%CI, -0.17 to 0.43; I2 = 0.0%, n = 5) was nonsignificant. Gluten challenge significantly worsened dyspeptic symptoms, including bloating, early satiety, and epigastric pain, but did not affect nausea. These findings suggest that gluten restriction could be efficient in reducing dyspeptic symptoms. Well-designed large RCTs recruiting homogenous groups of patients with functional dyspepsia are needed to clarify the effectiveness of gluten restriction on dyspeptic symptoms.

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

BackgroundRemimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery.MethodsPatients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery.ResultsThe incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05).ConclusionsIn this study, remimazolam did not increase the incidence and severity of PONV compared with propofol.Trial registrationKCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study.

Objective: The optimal dose of epidural morphine after cesarean section (CS) still remains unknown when combined with low-concentration ropivacaine based on a continuous basal infusion (CBI) mode. The aim of this study was to assess the impact of different dose of epidural morphine plus ropivacaine on maternal outcomes. Materials and methods: Data of parturients who received epidural analgesia for CS at a teaching hospital from March 2021 to June 2022 were retrospectively collected. Parturients were divided into two groups (RM3 group and RM6 group) according to different medication regimens of morphine. The implementation of epidural analgesia was performed with 3mg morphine in RM3 group and 6mg morphine in RM6 group in combination with 0.1% ropivacaine via a CBI pump. The primary outcomes included pain intensity at rest and movement and the incidence of urinary retention and pruritus within postoperative 48h. The secondary outcomes included the incidence and severity of postoperative nausea and vomiting (PONV) and pruritus, the rate of rescue analgesia and grading of motor Block. Results: Totally, 531 parturients were eligible for the final analysis, with 428 and 103 parturients in the RM3 group and RM6 group, respectively. There were no statistically significant differences in the visual analogue scores (VAS) at rest and movement within postoperative 48h between the two groups (all p > 0.05). Compared with the RM6 group, the incidence of urinary retention was lower in the RM3 group within 48h after CS (4.0% vs. 8.7%, p = 0.044). No significant difference was found in the incidence and severity of PONV and pruritus, the rate of rescue analgesia and grading of motor block between RM3 and RM6 groups. Conclusion: Epidural 3mg morphine plus 0.1% ropivacaine in a CBI mode can provide equal efficacy and have lower incidence of urinary retention compared with 6mg morphine after CS.

Effects of Intraoperative Saline-Soaked Pharyngeal Packing on Nausea, Vomiting, and Throat Pain After Nasal Surgery: A Systematic Review and Meta-Analysis

Background and Objectives: The purpose of this study was to conduct a meta-analysis of the effects of intraoperative pharyngeal packing on postoperative nausea, vomiting, and sore throat in nasal surgery patients.Methods: Databases were searched from inception to December 2022. Randomized controlled trials comparing saline-soaked pharyngeal packing (packing group) with no packing (control group) during intubation in patients undergoing nasal surgery were included. The primary outcomes of interest were the incidence of postoperative nausea, vomiting, and sore throat at 24 hours.Results: Eleven studies, including a total of 931 patients, were included. There was no significant difference between the two groups in the incidence of postoperative nausea and vomiting and severity scores at 2, 6, and 24 hours postoperatively. The incidence of throat pain was higher in the packing group than in the control group immediately after surgery and at 24 hours postoperatively. However, no significant difference was observed between the two groups in the incidence of sore throat at 6 and 12 hours postoperatively.Conclusion: Intraoperative saline-soaked pharyngeal packing did not significantly decrease postoperative nausea and vomiting. However, the use of pharyngeal packing was associated with a higher incidence of sore throat in the initial recovery period.