Nausea Control by Needling at Acupuncture Point Neiguan (PC6) During an Intraoral Impression-Taking Procedure

The objective of this study was to evaluate the effectiveness of acupuncture point PC6 (Neiguan) in controlling nausea during intraoral impression taking. This study was conducted in Piracicaba, São Paulo, Brazil. The sample consisted of 33 adult volunteers with nausea, who were randomly divided into control and study groups, and treated with nonpenetrating sham acupuncture and real acupuncture, respectively, at acupoint PC6. The two groups had two maxillary impressions taken, one prior to acupuncture and the other after acupuncture. The nausea assessment was made using the visual analog scale, Gagging Severity Index (GSI), and Gagging Prevention Index. Volunteers' expectation that nausea would be reduced through acupuncture was also assessed. For statistical analysis, we used the t test and the Spearman correlation (p < 0.05). When assessed by Gagging Severity Index/Gagging Prevention Index, nausea was reduced in the real acupuncture group (p < 0.01). In the visual analog scale assessment, similar reductions of nausea were noted in both groups (p > 0.05). No correlation existed between the expected and the actual reductions in nausea. Our results indicate that acupoint PC6 was effective for controlling nausea during the maxillary impression-taking procedure. Patients' expectation did not influence the results.     

姜辣素对顺铂致大鼠异嗜模型行为的作用

目的研究姜辣素对顺铂所致大鼠异嗜高岭土模型的影响并观察外周和中枢c-fos蛋白的表达。方法大鼠随机分成正常对照组、模型组、昂丹司琼+地塞米松组、阿瑞吡坦+地塞米松组、姜辣素组及姜辣素+地塞米松组,24 h及72 h记录各组摄食量及食高岭土量。免疫组化方法观察脑和回肠中c-fos蛋白的表达。结果 24 h内,姜辣素组、姜辣素+地塞米松组摄食量增加,啃食高岭土量减少,姜辣素组与姜辣素+地塞米松组相比摄食量增加(P<0.05);48～72h内,姜辣素组食高岭土量减少(P<0.05)。姜辣素组、姜辣素+地塞米松组c-fos阳性表达颗粒的灰度值明显高于模型组(P<0.05)。结论姜辣素可促进摄食并可抑制顺铂所致的大鼠异嗜高岭土行为,地塞米松对姜辣素无辅助作用。     

耳穴贴压治疗微创脑血管减压术后恶心呕吐的体会

目的探讨中医传统疗法耳穴贴压预防和缓解微创脑血管减压术后恶心、呕吐等并发症的临床疗效。方法将80例原发性三叉神经痛、面肌痉挛患者随机分为实验组、对照组各40例，对照组予以常规治疗护理；实验组除常规护理外，术后即予中药王不留行籽耳穴贴压，分别于术后6h，12h，24h、48h评定实验组和对照组患者恶心呕吐次数、程度，睡眠情况及患者的情绪。结果实验组恶心呕吐的发生率为22．5％，对照组为77．5oA，差异有显著意义（P〈0．01），且恶心呕吐的发生时间多在6～48h，48h后实验组与对照组比较，恶心、呕吐发生的例数及程度差异无显著意义（P〉O．05）；临床疗效比较实验组95％，对照组77．5％，差异有显著意义（P〈O．01）；情绪评价比较优良情绪实验组77．5％，对照组50％差异有显著意义（P〈0．05）。结论中药王不留行籽耳穴贴压，能有效预防和缓解微创脑血管减压术后恶心呕吐等并发症，改善患者情绪，提高患者舒适度。     

耳穴贴压用于预防乳腺纤维瘤摘除术后呕吐疗效观察

目的评价耳穴贴压预防喉罩辅助通气全凭静脉麻醉下乳腺纤维瘤摘除术患者术后呕吐的效果。方法选择年龄40岁以下、ASA评分Ⅰ级、乳腺纤维瘤摘除术患者80例,随机分为A组和B组,每组40例。A组在麻醉复苏阶段患者唤醒后于耳廓相应穴位寻找敏感点,采用耳穴贴压治疗。B组不予任何处理。术后不同时间随访观察两组患者恶心、呕吐次数及BP、HR、SpO2等生命体征变化。结果两组患者术后4 h和24 h BP、HR、SpO2比较,差异均无统计学意义(P0.05);A组患者术后恶心、呕吐发生率低于B组,两组比较差异具有统计学意义(P0.01)。结论耳穴贴压具有良好的预防全凭静脉麻醉下乳腺纤维瘤摘除术患者术后恶心、呕吐的作用,且无明显不良反应。     

Economic and clinical burden of opioid-induced nausea and vomiting

Opioids are the standard of care for treating moderate-to-severe pain; however, their efficacy can be limited by adverse events (AEs), including nausea and vomiting. Opioid-induced nausea and vomiting (OINV) is an inherent adverse effect of opioid treatment, exerting effects centrally and peripherally. Opioid-related AEs can impact treatment adherence and discontinuation, which can result in inadequate pain management. OINV may persist long-term, negatively affecting patient functional outcomes, physical and mental health, patient satisfaction, and overall costs of treatment. Multiple factors may contribute to OINV, including activation of opioid receptors in the chemoreceptor trigger zone, vestibular apparatus, and gastrointestinal tract. Prophylactic or early treatment with antiemetics may be appropriate for patients who are at high risk for OINV.     

Postoperative nausea and vomiting – a narrative review of pathophysiology,pharmacotherapy and clinical management strategies

Introduction: Postoperative nausea and vomiting (PONV) are common complications concerning patients undergoing general anesthesia. Intensive research was performed during the last two decades in order to develop therapeutic and prophylactic strategies to prevent this complication.

Areas covered: This article reviews the pathophysiology as well as pharmacological aspects of PONV prophylaxis and treatment. Relevant strategic aspects for pharmacological prophylaxis of PONV are discussed and clinical standard operating procedures are presented.

Expert opinion: The expert opinion focuses on poor implementation of actual PONV guidelines and future considerations.     

Small doses of droperidol do not present relevant torsadogenic actions: a double-blind,ondansetron-controlled study

AIM

Drugs used for postoperative nausea and vomiting prophylaxis are believed to provoke torsadogenic changes in cardiac repolarization. The aim of this study was to assess the effect of small doses of droperidol on the parameters of cardiac repolarization, including the QT_c interval and transmural dispersion of repolarization.

METHODS

A total of 75 patients were randomly allocated to receive 0.625 or 1.25 mg droperidol or 8 mg ondansetron. The QT_c interval was calculated using Bazett''s formula and the Framingham correction. The transmural dispersion of repolarization was determined as T_peak–T_end time.

RESULTS

Transient QT prolongation, corrected with both formulae, followed 1.25 mg of droperidol 10 min after administration. No change in the QT_c value was observed in the other groups. When corrected with Bazett''s formula, QT_c was prolonged above 480 ms in two patients receiving 1.25 mg droperidol (at the 10^th and 20^th minute of the study) and in one receiving ondansetron. No patients developed a QT_cB prolongation over 500 ms. No increase above 480 ms was observed relative to the Framingham correction method. There were no significant differences in the T_peak–T_end time either between or within the groups.

CONCLUSION

In men without cardiovascular disorders small doses (1.25 mg) of droperidol prophylaxis induced transient QT_c prolongation without changes in transmural dispersion of repolarization. The apparently low risk of the drug applies only in low risk male patients with a low pro-QT_c score.