Postoperative nausea and vomiting in children using patient-controlled analgesia: the effect of prophylactic intravenous dixyrazine

BACKGROUND: Although patient-controlled analgesia (PCA) with morphine provides a high degree of satisfactory postoperative analgesia in children, it is often associated with a high incidence of postoperative nausea and vomiting (PONV). Our aim in this study was to evaluate the prophylactic effect of dixyrazine, a phenothiazine with proven anti-emetic properties. METHODS: The incidence of nausea and vomiting was studied in 60 children using PCA after major surgery. The patients were randomised to receive either dixyrazine 0.25 mg kg-1 or placebo on the induction of anaesthesia in a double-blind, placebo-controlled design. The anaesthetic technique was standardised. The PCA pump was programmed to deliver bolus doses of morphine of 20 micrograms kg-1 with a continuous background infusion of 8-10 micrograms kg-1 h-1. Nausea, vomiting, sedation and pain scores were noted every 3 h for a period of 24 h. RESULTS: The morphine consumption of morphine was the same in both groups. During the stay in the recovery room the incidence of vomiting was 3% in the dixyrazine group compared to 30% in the placebo group (P < 0.05). On the ward, 57% versus 83% of the children vomited (P < 0.05). Rescue antiemetics were significantly lower, 30%, in the dixyrazine group compared to 60% in the placebo group (P < 0.05). Higher sedation scores were recorded for the dixyrazine group in the recovery room. No other adverse effects were found. CONCLUSION: A significant number of children using PCA with morphine after major surgery experience PONV. Although prophylactic dixyrazine reduces the incidence and severity of vomiting, the incidence still remains high.     

Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia

This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra-operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.     

Increased incidence of retching and vomiting during periovulatory phase after middle ear surgery

Purpose  

To assess the effect of the menstrual cycle on post-operative retching and vomiting (R& V) after middle ear surgery, and the efficacy of prophylaxis against R& V in female patients with transdermal scopolamine during either general or local anaesthesia and with intravenous ondansetron during general anaesthesia.     

Treatment of post-operative nausea and vomiting: comparison of propofol,droperidol and metoclopramide

Purpose  

To compare the efficacy of propofol in a subhypnotic dose (10 mg iv), droperidol (1.25 mg iv), or metoclopramide (10 mg iv) in the treatment of PONV in the post anaesthesia care unit (PACU).     

盐酸恩丹西酮预防化疗所致呕吐Ⅱ期临床研究

观察国产５－ＨＴ３阻滞剂－盐酸恩丹西酮预防化疗所致呕吐的临床疗效。方法：采用随机自身交替对照方法分为两组观察，接受顺铂联合化疗组及非顺铂联合化疗组各２５例。盐酸恩丹西酮８ｍｇ，化疗前１５分钟静注，恩丹西酮８ｍｇ，化疗后８小时口吸口服。对照组：胃复安２０ｍｇ，化疗前１５分钟肌注，胃复安８ｍｇ化疗后８小时口服。     

术中液体治疗量对100例妇科腔镜患者术后恶心呕吐的观察

目的　比较术中补充30 ml/kg乳酸林格液与10 ml/kg乳酸林格液的妇科腔镜患者术后恶心呕吐的发生率。方法　选择100名ASAⅠ~Ⅱ级择期行妇科腔镜不孕查因的患者, 随机分为两组, Ⅰ组患者入手术室至手术结束出麻醉恢复室前共接受30 ml/kg 乳酸林格液, Ⅱ组患者入手术室至手术结束出麻醉恢复室前接受10 ml/kg乳酸林格液, 观察术后发生恶心呕吐的患者例数及需要补救止吐药例数。结果　两组患者年龄、体重、禁食时间、手术操作时间差异无显著性; 术后48h恶心呕吐发生率, 30 ml/kg组较10 ml/kg组明显降低(P<0 05),需要补救止吐药人数30 ml/kg组较10 ml/kg组明显降低(P<0 05)。结论　与输注10 ml/kg乳酸林格液相比,术中输注30 ml/kg乳酸林格液可以降低妇科腔镜患者术后恶心呕吐的发生率。     

No difference between bupivacaine in 0.9% and 8% glucose for spinal anaesthesia in small children

BACKGROUND: Baricity is one of the most important factors to influence the characteristics of distribution of the local anaesthetic and hence success and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated. METHODS: Two hyperbaric bupivacaine solutions, in 0.9% and in 8% glucose, for spinal anaesthesia were investigated in 60 children, aged 1-7 years, in a double-blind, randomised, parallel group, prospective study. The children were premedicated with diazepam orally. Bupivacaine 5 mg ml(-1) in either 0.9% or 8% glucose was injected in a dose of 0.4 mg kg(-1). Maximum cephalad extent and regression of sensory block were tested by transcutaneous electrical stimulation. RESULTS: Success rate, spread and duration of sensory block were similar in both groups. Only one child required a single dose of fentanyl during surgery. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. Time to reach T10 did not differ between the groups. The incidence of adverse effects was similar. Atropine was administered to one child in each group to treat bradycardia and 6 children (10%) experienced shivering. One child in each group vomited once. CONCLUSION: These results demonstrate that bupivacaine in 0.9% glucose and in 8% glucose solutions are equally suitable for spinal anaesthesia in small children. Similar success rate, spread and duration of the sensory and motor block are achieved with both baricities of bupivacaine.     

Evaluation of three risk scores to predict postoperative nausea and vomiting

BACKGROUND: So far there are three different scores to predict postoperative vomiting (PV: Apfel et al., 1998) or postoperative nausea and vomiting (PONV: Koivuranta et al., 1997; Palazzo and Evans, 1993). All three scores used logistic regression analysis to identify and create weights for the risk factors for PV or PONV. In short, these were sex, age, history of previous PONV, motion sickness, duration of anaesthesia, and use of postoperative opioids. However, an external evaluation and a comparison of these scores has not been performed so far. METHODS: Patients undergoing a variety of surgical procedures under general anaesthesia were studied prospectively. Preoperatively, they completed a questionnaire concerning potential risk factors for the occurrence of PV or PONV implemented in the three risk scores. Balanced anaesthesia (induction agent, nondepolarising neuromuscular blocker, opioid, and inhalation agent in nitrous oxide/oxygen) was performed. No intravenous anaesthesia or any antiemetic prophylaxis was applied. Postoperatively, the patients were observed in the recovery room for the occurrence of PV and PONV and were visited twice on the ward within the 24-h observation period. Both the patients and the nursing staff were asked whether PV or PONV was present. The severity of PONV was categorised using a standardised scoring algorithm. A total of 1,444 patients was finally included into the analysis. Using information of the predicted risk for the individual patients and the actual occurrence of PV or PONV, Receiver Operator Characteristics (ROC-curves) were drawn. The area under each ROC-curve was calculated as a means of the predictive properties of each score and was compared for statistical differences. RESULTS: For prediction of PONV (any severity) the AUC-values (AUC=area under the curve) and the corresponding 95%-confidence intervals were: Apfel: 0.70 (0.67-0.72); Koivuranta: 0.71 (0.69-0.73); Palazzo: 0.68 (0.65-0.70). For prediction of PV: Apfel: 0.73 (0.71-0.75); Koivuranta: 0.73 (0.70-0.75); Palazzo: 0.68 (0.65-0.70). Thus, all three scores appeared to have a moderate accuracy as measured by the AUC. The score of Koivuranta predicts PONV (P=0.007) and also PV (P=0.002) significantly better than Palazzo's score. Furthermore, for predicting of PV the score of Apfel was also superior to Palazzo's score (P=0.005). All three scores predict PV with the same accuracy as PONV. CONCLUSION: The occurrence of PV and PONV in patients undergoing surgery under balanced anaesthesia can be predicted with moderate but acceptable accuracy using one of the available risk scores, regardless of local surgical or anaesthesiological circumstances. For clinical practice, we recommend the score published by Koivuranta, since its calculation is very simple.     

氟西汀减轻癌症化疗所致恶心呕吐的临床研究

[目的]探讨化疗所致恶心呕吐与抑郁症的关系及临床应用氟西汀进行干预的可行性.[方法]采用随机、前瞻性的自身对照研究,共52例患者入组,34例进行治疗组,接受氟西汀20mg/天,连用14天或以上;对照组18例,未予氟西汀治疗.[结果]化疗所致恶心呕吐的严重程度与抑郁密切相关(Rs=0.225,F=14.505,P=0.000);恶心呕吐情况,治疗组稳定和有效30例(88.2%),对照组11例(61.1%,X2=5.191,P=0.023).氟西汀的副作用少且可耐受.[结论]氟西汀能有效降低恶心呕吐的严重程度,值得临床进一步研究.