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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This prospective study was conducted to determine the sedative effects of IV ketamine and fentanyl on vital signs and behavior. Twenty-seven children, classified as ASA I, with a mean age of 34 months, were studied. The dosages of IV ketamine and fentanyl given were 0.5 mg/kg and 0.5 mcg/kg, respectively, approximately every 15-20 min. The pulse rate averaged 125 throughout the case. Blood pressure averaged 112/64. The respiration rate averaged 22 breaths per min. Mean behavior composite scores were 1.9 at the initial examination and 3.3 during treatment. One child vomited during treatment. Post-treatment complications were discomfort in 19% (5), nausea in 22% (6), and vomiting in 15% (4) of the patients. We concluded that IV sedation of precooperative healthy pediatric patients with ketamine, fentanyl, and nitrous oxide/oxygen appears to be a safe and effective sedation modality with minimal side effects when administered and monitored by a qualified anesthetist, offering the practitioner an alternative to general anesthesia.
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PMID:IV sedation in pediatric dentistry: an alternative to general anesthesia. 130 25

Sulfasalazine is an important therapeutic agent in the management of chronic inflammatory bowel disease (CIBD). Unfortunately, adverse reactions to this drug have been reported in 5-55% of treated patients. These include dose-related side effects like nausea, malaise, and headache or hypersensitivity reactions such as rash, fever, hives, arthralgia, hepatitis, etc. Studies in adults with successful reintroduction of sulfasalazine after a desensitization program have been reported; however, with regard to children, no such data are available. Fourteen children and adolescents (5-16 yr old) diagnosed to have CIBD manifested hypersensitivity to sulfasalazine within 2 months of onset of treatment. All had pancolitis--secondary to Crohn's disease (CD) in four and to ulcerative colitis (UC) in 10. All of them were on steroids. Sulfasalazine was discontinued in all after symptoms of hypersensitivity developed. Three patients with severe reaction were diagnosed prior to desensitization experience. Desensitization, beginning with 5-50 mg of sulfasalazine/day, was attempted in the other 11 children. The dose was gradually increased by 5-50 mg increments every 3 days. Desensitization was successful in only five children, who were ultimately able to tolerate 1.5-3.0 g of sulfasalazine daily again. In the rest (six of 11 patients), oral 5-ASA (Asacol) was administered, and three could not tolerate it. One of these three with intolerance to Asacol required colectomy. One did not tolerate Asacol or Dipentum. Our findings suggest that sulfasalazine desensitization should be attempted in all patients developing hypersensitivity reactions before trying alternative therapy.
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PMID:Sulfasalazine desensitization in children and adolescents with chronic inflammatory bowel disease. 809 41

The efficacy and safety of prophylactic intravenous ondansetron in preventing postoperative nausea and vomiting was investigated in a randomized, stratified, double-blind, placebo-controlled, dose-comparison study of 580 ASA physical class I and II female outpatients undergoing gynaecological surgery and receiving general anaesthesia. Patients received either ondansetron 1, 4 or 8 mg, or placebo i.v. immediately prior to a standardized technique for induction and maintenance of anaesthesia. All patients were intubated and received nitrous oxide and a narcotic. All doses of ondansetron were significantly more effective than placebo in preventing emesis over the 24 h postoperative period. Ondansetron significantly decreased nausea and emesis scores over 24 h postoperatively without causing sedation. No changes in laboratory parameters (haematology, blood chemistry, and liver enzymes) or vital signs (heart rate, blood pressure, and respiratory rate) were observed. Headache and dizziness were the most common side-effects; however, their incidence was the same as with placebo. Ondansetron was generally well tolerated, as evidenced by an adverse event, laboratory safety, and vital sign profile similar to placebo. Ondansetron 4 mg was found to be the optimal prophylactic i.v. dose for female outpatients over the entire 24 h postoperative period. Higher doses may offer an added benefit in some patients, such as those with a history of nausea and vomiting following general anaesthesia.
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PMID:Prophylactic intravenous ondansetron in female outpatients undergoing gynaecological surgery: a multicentre dose-comparison study. 142 25

Thirty patients, scheduled for short urological surgical procedures and ranked ASA 1 or 2, were randomly assigned to two homogenous groups. In group P, they were given a 2 mg.kg-1 bolus of propofol and 10 micrograms.kg-1 of alfentanil, followed by a continuous infusion of propofol (5 mg.kg-1.h-1) and 5 micrograms.kg-1 doses of alfentanil. In group E, they were given a 0.3 mg.kg-1 bolus of etomidate, followed by an infusion (1.5 mg.kg-1.h-1). The doses of alfentanil were the same as in group P. Further doses of either propofol (0.5 mg.kg-1) or etomidate (0.2 mg.kg-1) were used should anaesthesia prove not to be deep enough. The patients were not intubated, and breathed spontaneously. Surgery lasted a mean of 18.3 +/- 11.8 min (group P) and 18.8 +/- 9.4 min (group E). The following parameters were studied: the amount of each agent required for maintenance of anaesthesia, the duration of apnoea at induction, the quality of anaesthesia and of muscle relaxation, adverse effects (coughing, trismus, restlessness, nausea, vomiting), the time required for recovery, and its quality. In group P, there was a 27% decrease in arterial pressure, without any tachycardia or hypoxia, together with a quick recovery of excellent quality. On the other hand, in group E, there was little or no haemodynamic alteration, but there often was a trismus at induction. Hypoxia also occurred during induction with etomidate, being severe enough in one case to require tracheal intubation and artificial ventilation. The reasons for this hypoxia seemed to be the apnoea and the trismus, which tends to hinder assisted ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Propofol versus etomidate in short-time urologic surgery]. 144 8

At the beginning, the way intrathecal morphine was used for postoperative pain relief was quite unfortunate, because the doses derived from experience with morphine-tolerant cancer patients were considerably too high and respiratory depression occurred frequently. Subsequent dose-finding studies showed that the doses of morphine used initially could be reduced by a factor of ten without loss of the analgesic effect and with a marked reduction in side-effects. No respiratory depression has been reported when doses below 0.1 mg morphine are used. METHOD. In this prospective study the effect of 0.06 to 0.08 mg intrathecal morphine, mixed with the local anaesthetic for spinal anesthesia, was investigated in surgical patients aged 21 to 81 years, ASA grade I or II, scheduled for orthopaedic operations or herniorraphies. Thirty unpremedicated patients were enrolled in the study and were, after informed consent, randomly allocated to a control group without morphine or to a morphine group. The analgesic effect was assessed by the time interval between the administration of the spinal anaesthesia and the first demand for an analgesic medication. The mood state was evaluated with the adjective checklist of Janke and Debus 6 h after the spinal anaesthesia. RESULTS AND DISCUSSION. In the control group half of the patients asked for an analgesic medication within 275 min (median) after the spinal anaesthesia, and all patients within 420 min, whereas in the morphine group half of the patients asked for an analgesic within 1170 min (median). Seven patients had not required an analgesic at the termination of the observation period 20 h after the spinal anaesthesia. The mood status showed no difference between the two groups, in particular, no dizziness or drowsiness after morphine. There was no difference in the incidence of side-effects such as nausea or urinary retention between the two groups. Pruritus was not reported spontaneously but was found upon questioning in five patients. It was in no case disturbing. CONCLUSIONS. Morphine (0.06 to 0.08 mg) mixed with the local anaesthetic for spinal anaesthesia provided for an analgesia of more than 20 h duration in half of the patients. This technique is safe, simple, reliable and virtually free of side-effects. No particular supervision due to the administration of intrathecal morphine is necessary in this dose range if systemic opiates are avoided. If the analgesia is unsatisfactory, a non-opioid analgesic is recommended.
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PMID:[Intrathecal morphine for postoperative pain]. 146 57

Several studies comparing retrobulbar block (RB) and general anaesthesia (GA) for cataract surgery in the elderly have been published. Most of them were retrospective. Our prospective study was designed in order to determine the benefits or disadvantages using RB or GA. Arterial blood gases (ABG) and cardiovascular stability were explored in high-risk patients undergoing elective unilateral cataract extraction. METHODS. Forty patients over 65 years of age and with other co-existing diseases (ASA III-IV) were allocated randomly to receive either GA or RB. No premedication was given to either group of patients. On arrival in the anaesthetic room, a radial artery was cannulated for collection of blood samples and direct monitoring of the blood pressure. Pulse oximetry and ECG were continuously monitored in all patients, the end-expiratory CO2 (F(eexCO2)) only in the GA group. GA was induced with vecuronium 0.1 mg/kg and thiopentone 5 mg/kg; the lungs were ventilated with 100% oxygen. After intubation of the trachea controlled mechanical ventilation was continued with N2O/O2 (55:45) and enflurane 1%-2%. Only enflurane concentrations were varied to correct changes in mean arterial pressure (MAP) if these exceeded +/- 20%. Respiratory frequency and tidal volume were kept constant until completion of surgery. The patients were extubated when they were able to ventilate more than 5 1/min (pressure support 10 cmH2O; PEEP 5 cmH2O). After extubation no O2 was given. In the RB group neural block was undertaken with prilocaine 2% (3 ml) as a retrobulbar injection and prilocaine 1% (5 ml) to block the facial innervation of the orbicularis muscle (Van Lint, O'Brien). Oxygen 3 1/min was administered by nasal tube during the operation. Nine arterial samples for blood gas analysis were collected: (1) control; (2) before operation; (3) 5 min after beginning the operation; (4) 15 min after beginning the operation and before i.v. administration of 500 mg acetazolamide over 5 min; (5) after acetazolamide; (6 and 7) 10 and 20 min after acetazolamide; and (8 and 9) 15 and 30 min after operation (RB) or extubation (GA). RESULTS. The patient demography, including duration of anaesthesia and operation, was similar in both groups (Table 1). Four patients in the GA group (2 needed O2 after extubation because of hypoxaemia) and 2 in the RB group were excluded. No significant differences were seen in base excess (BE) and standard bicarbonate (SHCO3). Arterial O2 tension, arterial O2 saturation, and pulse-oximetric O2 saturation were higher in the RB group intra- and postoperatively (Figs. 1, 3, 4). Arterial CO2 tension (PaCO2) was significantly higher in the GA group during the pre- and postoperative period (Fig. 2), but not during the operation. The PaCO2- F(eexCO2) gradient ranged between 5 and 9 mmHg. Administration of acetazolamide did not influence this gradient by regressive analysis. The postoperative outcome of the patients was comparable in both groups. Nausea or vomiting did not occur. MAP was significantly higher in the RB group during the operation. No significant differences were seen in the pre- and postoperative period. Heart rate in the GA group was higher only after extubation, but was within physiological limits. DISCUSSION. Despite the differing results between the two groups, our study showed no important advantage related to either RB or GA. Changes in ABG, MAP, and heart rate during the investigation period were within physiological limits in elderly patients. Intravenous acetazolamide did not influence ABG in a significant manner. With regard to the preference of each patient, we recommend both RB and GA for cataract surgery in high-risk patients on the assumption of sufficient preoperative treatment of co-existing diseases. In conclusion, cardiovascular and ABG stability were maintained during both anaesthetic techniques.
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PMID:[General anesthesia vs. retrobulbar anesthesia in cataract surgery. A randomized comparison of patients at risk]. 152 60

This study was undertaken to compare desflurane with propofol anesthesia in outpatients undergoing peripheral orthopedic surgery. Data were combined from two institutions participating in a multicenter study. Ninety-one patients, ASA physical status I or II, were each randomly assigned to one of four groups. After administration of fentanyl (2 micrograms/kg) and d-tubocurarine (3 mg), intravenous propofol was administered to induce anesthesia in groups I and II and desflurane in groups III and IV. Maintenance was provided by desflurane/N2O in groups I and III, propofol/N2O in group II, and desflurane/O2 in group IV. Emergence and recovery variables, psychometric test results, and side effects were recorded by observers unaware of the experimental treatment. Patients in group II experienced less nausea than other groups (P = 0.002) despite this group having required more intraoperative fentanyl supplementation than groups III and IV (P = 0.01). Time to emergence, discharge, and psychometric test results were similar in all groups. Desflurane appears to be comparable with propofol as an outpatient anesthetic, facilitating rapid recovery and discharge home.
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PMID:Comparison of desflurane with propofol in outpatients undergoing peripheral orthopedic surgery. 153 Jan 70

We studied 114 female patients (ASA 1 or 2) who were within 20% of ideal body weight and who were scheduled to undergo gynaecological laparoscopy which required supplementation with an opioid (groups IA and PA), or dental procedures which did not require opioid supplementation (groups IO and PO). A computerised package of psychomotor tests was performed before surgery. Anaesthesia was induced with propofol 2.5 mg.kg-1 and all patients received atracurium 0.3 mg.kg-1 and 67% nitrous oxide in oxygen. Patients in group IA received isoflurane 1% (inspired), and alfentanil 10 micrograms.kg-1 as a bolus and 10 micrograms.kg-1.h-1 as an infusion. Patients in group PA received propofol 9 mg.kg-1.h-1 as an infusion, decreasing to 6 mg.kg-1.h-1 after 15 min, together with alfentanil 10 micrograms.kg-1.h-1. Patients in groups IO and PO received isoflurane and propofol in the regimens described for groups IA and PA, but without alfentanil. Recovery was assessed by a blinded observer who recorded times to awakening (eye opening) and orientation (giving date of birth), and who repeated the psychomotor tests at 1, 3 and 5 h. Linear analogue scales of mood, nausea and pain were obtained and other side effects were noted in the succeeding 48 h. A matched control group of 25 females (who were not anaesthetised) underwent psychomotor testing on four occasions in order to assess the 'learning effect' of repeated recovery testing. The analysis of recovery tests did not assume a normal distribution.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double-blind controlled trial. 837 80

Postoperative recovery after induction with either propofol or thiopentone has been compared in forty ASA I unpremedicated day surgery patients undergoing surgical extraction of third molar teeth under relaxant general anaesthesia. Mean recovery times in the propofol group, required for patients to sit out of bed (44.8 minutes; SD 18.6) and meet discharge criteria (113.1 minutes; SD 34.5) were significantly (P less than 0.05) shorter than those in the thiopentone group (59.7 minutes; SD 21.4 and 133.5 minutes; SD 34.5). Fewer patients in the propofol group were treated in the recovery room for nausea and vomiting and the incidence of mild nausea not requiring treatment was less in the propofol group, but these differences were not statistically significant. Postoperative mental performance, measured by the FAST index, a new test of mental speed, was reduced on average by 1.7% of preoperative levels, during the recovery period tested, with no significant difference between the groups.
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PMID:Double-blind comparison of patient recovery after induction with propofol or thiopentone for day-case relaxant general anaesthesia. 159 51

We prospectively studied 952 patients to identify the incidence of hypotension (systolic blood pressure less than 90 mmHg), bradycardia (heart rate less than 50 beats/min), nausea, vomiting, and dysrhythmia during spinal anesthesia. Historical, clinical, and physiologic data were correlated with the incidence of these side effects by univariate and multivariate analysis. Hypotension developed in 314 patients (33%), bradycardia in 125 (13%), nausea in 175 (18%), vomiting in 65 (7%), and dysrhythmia in 20 (2%). Variables conferring increased odds of developing hypotension include peak block height greater than or equal to T5 (odds ratio 3.8, P less than 0.001), age greater than or equal to 40 yr (2.5, P less than 0.001), baseline systolic blood pressure less than 120 mmHg (2.4, P less than 0.001), combination of spinal and general anesthesia (1.9, P = 0.01), spinal puncture at or above the L2-L3 interspace (1.8, P less than 0.001), and addition of phenylephrine to the local anesthetic (1.6, P = 0.02). Variables conferring increased odds of developing bradycardia include a baseline heart rate less than 60 beats/min (odds ratio 4.9, P less than 0.001), ASA physical status classification of 1 versus 3 or 4 (3.5, P less than 0.001), current therapy with beta-adrenergic blocking drugs (2.9, P less than 0.001), and peak block height greater than or equal to T5 (1.7, P = 0.02). Variables conferring increased odds of developing nausea or vomiting include addition of phenylephrine or epinephrine to the local anesthetic (3.0-6.3, P less than or equal to 0.003), peak block height greater than or equal to T5 (odds ratio 3.9, P less than 0.001), use of procaine (2.6-4.4, P less than or equal to 0.003), baseline heart rate greater than or equal to 60 beats/min (2.3, P = 0.03), history of carsickness (2.0, P = 0.01), and development of hypotension during spinal anesthesia (1.7, P = 0.009). Our results indicate that the incidence of side effects during spinal anesthesia may be reduced by 1) minimizing peak block height; 2) using plain solutions of local anesthetics; 3) performing the spinal puncture at or below the L3-L4 interspace; and 4) avoiding the use of procaine in the subarachnoid space.
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PMID:Incidence and risk factors for side effects of spinal anesthesia. 843 44


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