Economic evaluation of ondansetron vs dimenhydrinate for prevention of postoperative vomiting in children undergoing strabismus surgery

BACKGROUND: Although rarely life-threatening, postoperative vomiting (POV) is a distressing complication. The incidence of POV ranges from 34 to 90% in children undergoing strabismus surgery when antiemetics are not administered prophylactically. METHODS: In this study, a cost-consequence analysis (CCA) is used to estimate the economic benefit of ondansetron and dimenhydrinate as antiemetics administered prophylactically in children undergoing strabismus surgery. This retrospective study was conducted at The Hospital for Sick Children based on a review of 70 charts. RESULTS: Ondansetron was more effective with 45.3 POV-free patients (PFP) in an adjusted cohort of 100, while dimenhydrinate resulted in 38.2 PFP in an adjusted cohort of 100. The costs were significantly different between the two groups, CAD dollars 185.90 (+/-26.37, 95% CI, CAD dollars 173,89; CAD dollars 197.90) and CAD dollars 232.90 (+/-CAD dollars 66.84, 95% CI, CAD dollars 198.53; CAD dollars 267.27) per patient for ondansetron and dimenhydrinate, respectively. The length of stay in the postanesthetic care unit (PACU) represented over 97% of total costs, and the mean lengths of stay in the PACU for ondansetron and dimenhydrinate were significantly different, 3.43 and 4.41 h, respectively. CONCLUSION: This study should serve as a pilot for a large-scale investigation on the correlation between the length of stay in the PACU and the antiemetic agent used.     

Formulation and evaluation of in situ gelling system of dimenhydrinate for nasal administration

Nasal drug delivery has a variety of advantages. Drugs can be rapidly absorbed through the nasal mucosa, giving rapid onset of action, and avoiding presystemic metabolism. In present study; the nasal mucoadhesive in situ gels of anti-emetic drug Dimenhydrinate were formulated using Gellan gum and Carbopol 934P. The in situ gels so prepared were characterized for gelation, viscosity, gel strength, mucoadhesion, drug content, drug diffusion, ex vivo permeation and histopathological studies. The optimized formulation passing from above tests was further subjected to accelerated stability study. It retained the good stability over the period of 90 days. From the overall performance this in situ gel seems to be an effective delivery system for the nasal route.     

桂利嗪片与哌醋甲酯缓释片配伍的抗运动病药效研究

目的 研究桂利嗪片与哌醋甲酯缓释片配伍的抗运动病效果。方法 人体实验检测8名男性受试者接受旋转刺激后的眼震电图变化;动物实验采用20条比格犬,以复合旋转刺激模式诱发其产生流涎、呕吐症状,比较各组动物的流涎、呕吐潜伏期。结果 受试者单独服用桂利嗪片或哌醋甲酯缓释片,或合用桂利嗪片与哌醋甲酯缓释片,在服药后1,2,4 h均能抑制旋转刺激诱导的眼震持续时间和平均慢相速度,但桂利嗪片与哌醋甲酯缓释片配伍的效果更强。比格犬药物处理后,阳性对照药物茶苯海明组、桂利嗪片与哌醋甲酯缓释片配伍的小剂量组流涎、呕吐潜伏期较对照组有延长趋势,但差异无统计学意义,而桂利嗪片与哌醋甲酯缓释片配伍的中剂量组和高剂量组流涎、呕吐潜伏期较对照组明显延长,且中剂量组流涎、呕吐潜伏期明显长于茶苯海明组。结论 桂利嗪片与哌醋甲酯缓释片配伍具有明显的抗运动病作用,且效果可能优于茶苯海明片。     

Asymptomatic Brugada Syndrome Case Unmasked During Dimenhydrinate Infusion

Typical ECG of that described for Brugada syndrome was elicited in a patient diagnosed with labyrinthopathy during infusion of dimenhydrinate, a first-generation antihistamine usually used to treat motion sickness. Although the patient had no history of syncope or palpitations, and there was no family history of cardiac disease or sudden death, the ECG abnormality was reproduced later with intravenous flecainide, and an asymptomatic Brugada syndrome was diagnosed.     

Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials

BACKGROUND: Diphenhydramine and its theoclate salt dimenhydrinate are traditional antiemetics still in use. However, so far the quantitative effect of dimenhydrinate in the prophylaxis of postoperative nausea and vomiting (PONV) has not been evaluated systematically. METHODS: Results from randomized controlled trials investigating the efficacy of dimenhydrinate vs. a control to prevent PONV were included in a meta-analysis. Studies were systematically searched through MEDLINE, EMBASE, the Cochrane-Library, manually screening of reference lists of matching review articles and current issues of locally available peer-reviewed anesthesia journals, up to June 2001. The numbers of patients with complete absence of PONV within 6 h and within 48 h after surgery were extracted as the main end point. Pooled relative benefits (RB) and numbers-needed-to-treat (NNT) with their corresponding 95% confidence intervals (CI) were calculated using a random effects model. This quantitative systematic review was performed following the recommendations of the QUORUM statement. In all, 18 trials with 3045 patients were included in the analysis: 1658 patients received a placebo (control) and 1387 patients received dimenhydrinate. RESULTS: The RB to stay completely free of PONV was 1.2 (95% CI: 1.1-1.4) for the early period (NNT = 8; 95% CI: 5-25) and 1.5 (1.3-1.8) for the overall investigated period (NNT = 5; 95% CI: 3-9). CONCLUSION: Dimenhydrinate is a traditional and inexpensive antiemetic with an efficacy that might be considered as clinically relevant. Although in use for a long time, the dose-response, precise estimation of side-effects, optimal time of administration and the benefit of repetitive doses still remain unclear.     

茶苯海明治疗晕动病的安全性和有效性

茶苯海明是一种抗组胺类药,是治疗晕动病的有效药物,具有显著的民用和军事应用价值.本文检索PubMed、the Cochrane Ear,Nose and Throat Disorders Group Trials Register、the Cochrane Central Register of Controlled Trials、EMBASE、CINAHL、Web of Science、BIOSIS Previews等数据库,归纳所有可获得的文献,综合分析茶苯海明治疗晕动病的安全性和有效性.结果显示,尽管治疗晕动病的首选药物是东莨菪碱,但茶苯海明是治疗晕动病伴发恶心和呕吐时的首选药物.这可能与茶苯海明能减少晕动刺激过程中胃的运动有关.因此在治疗伴有恶心和呕吐症状的晕动病时,应首选茶苯海明.     

Treatment of Acute Lead Intoxication — Choice of Chelating Agents and Supportive Therapeutic Measures

Abstract

This is a report of an intentionally administered overdose of dimenhydrinate to a 4 month-old infant who subsequently presented with status epilepticus, coma, and life threatening ventricular dysrhythmias. Initial toxicologic analysis of the serum by fluorescence polarization immunoassay was positive for tricyclic antidepressants. Repeat analysis of the serum at 6 hours post ingestion by gas chromatography mass spectrometry analysis defined diphenhydramine 4.8 μg/mL. The infant was managed with IV sodium bicarbonate as utilized in tricyclic antidepressant intoxication. The dysrhythmias resolved and the infant recovered without sequelae.     

茶苯海明含片的研制及质量评价

目的:制备口感适宜的茶苯海明含片并进行质量评价。方法:用正交试验筛选茶苯海明复合物的最佳制备条件;辅以甜味剂和矫味剂,湿法制粒制得茶苯海明口含片,采用非模型依赖法比较含片和普通片溶出曲线的相似性。结果:茶苯海明与EudragitE100使用量为1∶1,温度70℃,作用时间12 h时制得复合物口感较好;茶苯海明含片和普通片的溶出度相似(f2=67.29),含片口感外形俱佳,质量可控。结论:一定条件下Eudragit E100能较好遮掩茶苯海明的苦麻味。茶苯海明含片制备工艺可行。     

速效抗晕胶囊抗运动病作用的实验研究

目的研究速效抗晕胶囊抗运动病效果。方法采用大鼠条件性厌食症模型观测旋转刺激前后糖精水饮用量的变化；观测毕格犬旋转刺激后流涎、呕吐潜伏期变化。结果旋转刺激前，各组间大鼠糖精水饮用量没有差别；旋转刺激后对照组糖精水饮用量较旋转前明显减少（P〈0．01），而茶苯海明组、速效抗晕胶囊低、中、高剂量组大鼠糖精水饮用量较旋转前无显著性差别。给药前毕格犬对于旋转刺激均敏感，其流涎、呕吐出现时间较早；给药后，茶苯海明组、速效抗晕胶囊低剂量组流涎、呕吐潜伏期变化不明显，而速效抗晕胶囊中、高剂量组与对照组比较，流涎、呕吐潜伏期显著延长（P〈0．01）。结论速效抗晕胶囊具有抗运动病作用，并且效果优于茶苯海明。