Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral doxepin rinse has been reported to provide pain relief in patients with oral mucosal lesions due to cancer or cancer therapy. The purpose of this study was to assess the anesthetic effect of doxepin oral rinse in normal subjects to identify the duration of effect and to contrast the anesthetic effect with reported pain relief in patients with oral mucosal lesions. Normal volunteers were provided a solution of doxepin (5 mg/mL) for oral rinsing. Oral numbness and adverse effects were recorded for a period of 4 h after rinsing. Doxepin rinse resulted in mucosal anesthesia in all subjects. Sedation/fatigue was reported in four of seven subjects. There were no taste complaints and no nausea reported. The limited duration of numbness/anesthesia in normal subjects compared with prior studies showing pain relief for more than 3 h in patients with mucosal lesions, suggests that the extended duration of pain relief in patients was due to analgesic effects rather than anesthetic effects. The majority of normal subjects reported sedation after use, but this was less common in patients with mucosal lesions.
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PMID:Oral topical doxepin rinse: anesthetic effect in normal subjects. 1467 13

Living liver donors for adult liver transplant recipients undergo extensive liver resection. Partial donor hepatectomies may alter postoperative drug metabolism and hemostasis; thus, the risks and the benefits of pain management for this unique patient population may need to be reassessed. The safety and efficacy of combined epidural analgesia and field infiltration in our initial living liver donor group are presented. A thoracic epidural catheter was placed before general anesthesia in 2 female and 6 male donors (44.2 +/- 11.3 years old, mean +/- standard deviation [SD], range 26-56). At the end of surgery, incisions were infiltrated (bupivacaine 0.25%), and an epidural infusion was used (bupivacaine 0.1% + hydromorphone hydrochloride 0.02%). Clinical outcomes were followed for 5 days. The time sequence of pain intensity on a 0-10 visual analog scale clustered into 3 phases, the intensity of which differed significantly from each other (2.2 +/- 0.6, 0.69 +/- 0.2, and 2.37 +/- 0.3 respectively, P = 0.028). Right shoulder pain was observed in 75% of the donors. Sedation, pruritus, and nausea were minimal. Consistently maximal international normalized ratio elevation occurred at 17.6 +/- 7 hours postoperatively, then slowly declined. Platelet counts were lowest on day 3. No neurologic injury or local anesthetic toxicity was observed. This 2-site approach provided effective, safe, postoperative analgesia for our donors. Universally, coagulopathy ensued, indicating a potentially increased risk for epidural hemorrhage at epidural catheter removal and mandating close postoperative neurologic and laboratory monitoring. Research is needed to advance the understanding of postoperative coagulopathy and hepatic dysfunction in these donors to further optimize their perioperative management, including that of analgesia.
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PMID:Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management. 1500 62

This manuscript reviews apomorphine administration in formulations other than intermittent bolus injection, and comments on other potential uses for this unique compound. Continuous sc apomorphine therapy has been shown to alter peak-dose dyskinesia thresholds in advancing patients, and in some instances may replace all other anti-parkinson therapies. In general continuous infusion of sc apomorphine at a rate of 4 mg/h is well tolerated, and has been postulated to be equivalent to approximately 600 mg levodopa/day. This therapy is associated with skin complications, particularly nodule formation, and focal panniculitis is seen in more than 50% of subjects. Optimal dosages for intranasal apomorphine range from 2 to 5 mg per inhalation with benefit seen at 7.5 minutes and duration of effect of 45 to 55 minutes. Side effects included nasal irritation, vestibulitis, dyskinesias, yawning, and nausea. Comparison of 3 mg sc and 30 mg sublingual apomorphine in 9 Parkinson's disease subjects in a blinded cross-over trial found that the time to peak benefit was beyond 40 minutes with sl apomorphine, compared to 21 minutes in the sc preparation. Chronic use of the sublingual formulation was associated with severe stomatitis in half the subjects, and markedly limited the treatment. Rectal administration of apomorphine has been evaluated in limited, usually post-operative settings. Administration of a 200 mg apomorphine rectal suppository resulted in an average time to benefit of 32 minutes with an average duration of 195 minutes. Sedation, nausea and faintness were reported as side effects. Although the diagnostic confirmation potential of this agent has been questioned, the drug may have an important role in evaluating the potential for benefit in the deep brain stimulation surgical setting.
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PMID:Other formulations and future considerations for apomorphine for subcutaneous injection therapy. 1503 68

Nausea, vomiting and anxiety related to administration of cancer chemotherapy remain significant problems. This randomized, clinical trial was undertaken to evaluate the effect of sedation on the patient's comfort during chemotherapy infusion in patients with breast cancer. Forty-five breast cancer patients were randomized into three groups: Group I--chemotherapy, control, Group II--midazolam+chemotherapy, and Group III--propofol+chemotherapy. Nausea occured in 87% and vomiting in 13% of the patients in the control group, while none of the sedated subjects had these side-effects, although 76% of them had experienced then during previous cycles of chemotherapy. Compared with the control group, post-chemotherapy anxiety scores also improved with the addition of midazolam or propofol. Eighty percent of the subjects declared that they would prefer the sedative-containing regimen for their further cycles. Sedation with midazolam or propofol may improve the patient's comfort, and provide better control of chemotherapy-related side effects during chemotherapy infusion in breast cancer patients.
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PMID:Effect of sedation with midazolam or propofol on patient's comfort during cancer chemotherapy infusion: a prospective, randomized, double-blind study in breast cancer patients. 1603 28

In our study we aimed to reduce postoperative morphine consumption, prevent adverse effects of morphine, and improve analgesic quality via adding analgesic doses of ketamine infusion to intravenous morphine-patient controlled analgesia (PCA). After local ethics committee approval, 45 patients scheduled for total abdominal hysterectomy were included in the study. In the postoperative period the patients were separated into two groups randomly. After starting morphine-PCA in both groups, one group received ketamine infusion (Group K: n= 22), while the other group received saline infusion (Group S: n= 23) for 24 hours. There was no significant difference between the postoperative systolic and diastolic arterial pressures, heart rate and respiratory rate values. Visual Analogue Scale and Verbal Rating Scale measures was significantly lower in Group K (p<0.01). Total morphine consumption was higher in Group S (p<0.05). Sedation scores were significantly lower in Group K (p<0.05). When adverse effects were evaluated we found that nausea was higher in Group S (p<0.05), while there was no difference in the other side effects (p>0.05). Patient satisfaction was better in the 24th and 48th hours in Group K and was found to be statistically significant (p<0.05). Our results suggest that ketamine infusion added to opioids for postoperative analgesia, reduces total opioid requirement and prevents side effects.
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PMID:[Addition of ketamine infusion to patient controlled analgesia with intravenous morphine after abdominal hysterectomy]. 1678 69

Little information is available about the incidence, prevalence, or severity of morphine side effects during repeated individualized dosing for chronic cancer pain, although it has been widely used in this way for more than 30 years. The authors' aim was to describe the prevalence of symptoms possibly attributable to morphine side effects in a convenience sample of patients with pain due to advanced cancer. They used a prospective survey of inpatients and outpatients on regularly dosed morphine, with a questionnaire administered weekly for 4 weeks. Forty-two of 56 eligible patients completed at least the first questionnaire, with 30 completing all 4. Dry mouth was the most common symptom reported (point prevalence, 95%); this was often moderate to severe in intensity (57%) and was the most persistent symptom (period prevalence, 20%). Sedation and constipation were frequent (point prevalence, 88%) and was often moderate or severe at some point (55% and 62%, respectively) but had low period prevalence. Nausea was reported by less than half the patients. Myoclonus was common (point prevalence, 83%) but was usually mild and not persistent. Total daily morphine dose had little impact on side-effect patterns. Constipation, dysphoria, myoclonus, nausea, and sedation were more likely to be severe following dose increases. In conclusion, although constipation, nausea, and sedation are well described as side effects of morphine administration, others such as dry mouth and myoclonus appear to be underestimated. Validated patient-based measures of opioid side effects are needed.
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PMID:The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain. 1706 Feb 84

Opioid analgesics are useful agents for treating pain of various etiologies; however, adverse effects are potential limitations to their use. Strategies to minimize adverse effects of opioids include dose reduction, symptomatic management, opioid rotation, and changing the route of administration. Nausea occurs in approximately 25 percent of patients; prophylactic measures may not be required. Patients who do develop nausea will require antiemetic treatment with an antipsychotic, prokinetic agent, or serotonin antagonist. Understanding the mechanism for opioid-induced nausea will aid in the selection of appropriate agents. Constipation is considered an expected side effect with chronic opioid use. Physicians should minimize the development of constipation using prophylactic measures. Monotherapy with stool softeners often is not effective; a stool softener combined with a stimulant laxative is preferred. Sedation and cognitive changes occur with initiation of therapy or dose escalation. Underlying disease states or other centrally acting medications often will compound the opioid's adverse effects. Minimizing unnecessary medications and judicious use of stimulants and antipsychotics are used to manage the central nervous system side effects. Pruritus may develop, but it is generally not considered an allergic reaction. Antihistamines are the preferred management option should pharmacotherapy treatment be required.
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PMID:Management of common opioid-induced adverse effects. 1708 29

Nausea and vomiting are distressing symptoms in advanced cancer patients. The causes of nausea and vomiting are multifactorial. Among the causes is opioid therapy, the mainstay of cancer pain management. When nausea or other opioid side effects occur, it may hamper pain management and undermine the quality of life of cancer patients. Risperidone exerts an antiemetic effect in animals, but there has been no clinical report on its antiemetic activity. We conducted a retrospective chart review to examine whether risperidone is useful for opioid-induced nausea and vomiting in advanced cancer patients (n=20). Risperidone was given as doses of 1mg once a day. Complete response was observed in 50% of patients (10/20) for nausea and 64% (7/11) for vomiting. Sedation (n=2) was documented as an adverse effect. This observation suggests that risperidone can be an effective antiemetic drug in the treatment of refractory opioid-induced nausea and vomiting in advanced cancer patients.
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PMID:A retrospective chart review of the antiemetic effectiveness of risperidone in refractory opioid-induced nausea and vomiting in advanced cancer patients. 1754 49

Persons with intellectual disability have difficulty in cooperating with outpatient care, and many are referred for general anaesthesia. Intellectual disability has traditionally been a contraindication for conscious sedation. We evaluated the behavioural impact, effectiveness, and tolerance of sedation in this population using a fixed 50% nitrous oxide/oxygen mixture as a single agent. We used dental treatment as a model of outpatient care; 349 patients (192 males, 157 females; mean age 22y [SD 14]; range 3-81y) were recruited over a 12-month period at seven centres. Sedation was deemed successful if planned dental treatment was completed. Behaviour was scored with the modified Venham scale. Out of 605 sessions, 91.4% were successful. No serious adverse effects occurred. Minor adverse events (such as nausea) occurred in 10.1% of sessions. We conclude that the use of safe and effective conscious sedation may reduce the indications for general anaesthesia.
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PMID:Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability. 1763 9

The authors investigated, in a randomized, placebo-controlled, double-blinded study, the efficacy and safety of lornoxicam on pain after abdominal hysterectomy and on tramadol consumption in patients. Fifty patients were randomized to receive either oral placebo or lornoxicam 8 mg one hour before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50 percent N2O/O2 with a fresh gas flow of 2 L/min (50 percent N2O in O2) and fentanyl (2 microg/kg). All patients received patient-controlled analgesia with tramadol with loading dose of 50 mg; incremental dose of 20 mg; lock out interval of 10 minute; and four-hour limit 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after one hour. Patients were studied at one, two, four, eight, 12, and 24 hours for visual analogue (VAS) pain scores, heart rate, mean arterial pressure, periferic oxygen saturation, sedation, tramadol consumption, and length of hospitalization. VAS scores at one hour were significantly lower in the lornoxicam group (p < 0.001). The tramadol consumption at one, two, four, eight, and 12 hours was significantly lower in the lornoxicam group when compared with the placebo group (p < 0.001, p = 0.008, p = 0.029, p = 0.034, p = 0.042, respectively). Sedation scores were similar at all the measured times in the groups. Length of hospitalization was significantly shorter in lornoxicam group (4.8 +/- 0.4 day) than placebo group (5.2 +/- 0.5 day) (p = 0.005). There was difference in the incidence of nausea between the groups (p = 0.047). The number of patients and the doses of antiemetics given during the first 24 hours after surgery in lornoxicam group were less than those in placebo group (p = 0.003, p = 0.034, respectively). In conclusion, a single oral dose of lornoxicam given preoperatively enhanced the analgesic effect of tramadol, decreasing tramadol consumption and side effects, and shortened the length of hospitalization.
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PMID:Analgesic effects of lornoxicam after total abdominal hysterectomy. 1802 41


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