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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The antiemetic effects and side-effects of P6 acupuncture and droperidol pre-treatment were evaluated in a randomized, patient- and observer-blinded study. Ninety unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair, and aged over one year, were studied. All patients received intravenous thiopentone 5 mg.kg-1, atropine 0.02 mg.kg-1 and succinylcholine 1.5 mg.kg-1, and the trachea was intubated. Patients then received either intravenous droperidol 0.075 mg.kg-1, droperidol plus five minutes' P6 acupuncture, or acupuncture alone. Anaesthesia was maintained with nitrous oxide 66% and halothane 1.5-2.0% in oxygen with spontaneous ventilation. There was no difference in the incidence of vomiting in the droperidol group (17% before discharge from hospital and 41% up to 48 hours after discharge), combined treatment group (17% and 34% respectively) and acupuncture group (27% and 45% respectively). Corresponding figures for the incidence of vomiting before discharge were 17%, 17% and 27% respectively; these values were also not different. The incidence of restlessness was significantly greater in children receiving droperidol (63%) or both treatments (67%) than in those receiving acupuncture alone (30%; P = 0.007). P6 acupuncture and droperidol are equally ineffective in preventing vomiting within 48 hours of paediatric strabismus repair. Droperidol is associated with increased incidence of postoperative restlessness.
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PMID:Ineffectiveness of acupuncture and droperidol in preventing vomiting following strabismus repair in children. 154 95

Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part from the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.
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PMID:The use of hypnosis with cancer patients. 154 47

In a randomized double-blind study, the effects of clonidine premedication as a sedative, anxiolytic, analgesic and oculohypotensive agent were studied in 100 elderly patients (62 to 65 +/- 10 years, ASA grade I-II) undergoing elective intraocular surgery under local anaesthesia. The control group (Group A, n = 50) received oral diazepam 0.15 mg/kg 120 min before surgery and Group B (n = 50) received oral clonidine 300 micrograms 120 min before surgery. Two hours after the premedication, there was significantly more sedation (P less than 0.05) and less subjective anxiety (P less than 0.05) in the clonidine group than in the control group. There was a significant fall in intraocular pressure (IOP) from 20 +/- 0.5 to 13 +/- 0.5 mmHg (P less than 0.05) and significant reduction in systolic and diastolic blood pressure (BP) and heart rate (HR) (P less than 0.05) in the clonidine group as compared to the control group. Perioperatively, significantly more supplementation with i.v. diazepam was given in the control group than in the clonidine group (P less than 0.01). The incidence of intra-operative hypertension (P less than 0.01) and tachycardia (P less than 0.05) was significantly greater in the control group than in the clonidine group. A significantly larger number of patients in the clonidine group scored a Post-Anaesthesia Recovery (PAR) score of 10 as compared to the control group (P less than 0.01). There was no statistical difference in the postoperative Visual Analogue Scale (VAS) scores for pain, number of analgesic requests and emesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oral clonidine premedication for elderly patients undergoing intraocular surgery. 154 37

Forty-four children, ASA physical status I or II, aged 1.5-14 years and admitted for strabismus surgery, were studied. The study compared the postoperative condition after two different anesthesia methods. All children were premedicated with midazolam rectally, received glycopyrrolate i.v. and were then randomised to one of two anesthetic methods: 1) induction with thiopental, maintenance with halothane or 2) induction with propofol supplemented with fentanyl, maintenance with propofol infusion. In both groups, tracheal intubation was performed after vecuronium i.v. and the children were ventilated manually. Peroperatively, patients receiving propofol/fentanyl had more episodes of bradycardia (P less than 0.001). Times to spontaneous breathing and extubation were shorter in the propofol/fentanyl group (P less than 0.05) and there was also a lesser degree of sedation during the first 2 h postoperatively (P less than 0.01). Fewer children in the propofol/fentanyl group vomited postoperatively (P less than 0.05). The apprehension score was higher in the propofol/fentanyl group compared to the thiopental/halothane group (P less than 0.05). We conclude that children undergoing strabismus surgery anesthetized with propofol/fentanyl had more episodes of peroperative bradycardia, a lower incidence of postoperative vomiting and a shorter recovery time, and were more apprehensive during the initial postoperative period than children anesthetized with thiopental/halothane.
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PMID:Propofol-fentanyl anesthesia compared to thiopental-halothane with special reference to recovery and vomiting after pediatric strabismus surgery. 154 40

The ability to drink clear liquids without vomiting after anesthesia and surgery is a commonly used criteria for discharge of pediatric day surgery patients. We hypothesized that the ability to drink as a prerequisite for discharge would not affect the frequency of vomiting, delay discharge, or increase the frequency of readmission of children for dehydration after day surgical procedures. We randomized 989 patients between the ages of 1 month and 18.0 yr to one of two groups. The 464 "mandatory drinkers" were required to demonstrate the ability to drink clear liquids without vomiting prior to discharge from the hospital, whereas 525 "elective drinkers" were allowed but not required to drink. Other than the discharge criteria, the patients were managed in an identical fashion; the minimum volume of intravenous fluids received by all patients was adequate to supply a calculated 8-h fluid deficit prior to discharge from the hospital. There were no differences between the two groups in the incidence of vomiting in the operating room, the postanesthesia care unit, or after discharge from the hospital. However, in the day surgery unit, only 14% of the elective drinkers vomited compared to 23% of the mandatory drinker group (P less than 0.001). The mandatory drinkers had a more prolonged stay in the day surgical unit, averaging 101 +/- 58 min (mean +/- SD) compared to 84 +/- 40 min for elective drinkers (P less than 0.001). No patient in either group required admission to the hospital for persistent vomiting on the day of surgery, and no patient required readmission for vomiting or dehydration after discharge from the day surgery unit.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Should children drink before discharge from day surgery? 155 Feb 77

Epidural fentanyl is often added to epidural local anaesthetic agents to improve the quality of anaesthesia obtained during Caesarean section. Fentanyl may be given either before or after delivery of the infant. When given before delivery, fentanyl has not been reported to cause neonatal depression, although this remains a concern. A prospective, randomized, double-blind study was undertaken to determine if fentanyl was more effective if given before or after delivery of the baby in 64 women undergoing Caesarean section under lidocaine epidural anaesthesia. Maternal outcome was determined by time to achieve T4 neural blockade, the dose of lidocaine necessary to achieve this block and intraoperative scores for pain, nausea, vomiting, shivering, and sedation. Neonates were assessed by umbilical arterial blood pH and Apgar scores. No differences were detected in either group with respect to maternal or neonatal outcome. We recommend using only epidural local anaesthetic agents before delivery, and giving epidural fentanyl following delivery of the infant.
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PMID:Epidural fentanyl and caesarean section: when should fentanyl be given? 840 64

The cause of postanesthesia shaking (PS) is unknown. PS develops spontaneously and unpredictably in up to 67% of patients emerging from general anesthesia, and it continues for minutes to hours when not treated with medications or radiant heat lamps. The purposes of this study were to (1) examine whether butorphanol tartrate (Stadol; Anaquest, Madison, WI/Bristol-Meyers Squibb, Evansville, IN), meperidine (Demerol; Winthrop, NY, NY), and morphine are differentially effective in suppressing PS, (2) compare PS suppression by sex, and (3) determine time to PS development. PS, measured on a 0 to 3 visual scale, developed in 120 of 533 patients (23%). Medication treatment was initiated for 66 of 120 patients by PACU nurses following standard policies and procedures for intravenous doses of 1 mg butorphanol (n = 12), 15 to 30 mg meperidine (n = 18; n = 23), or 2 to 4 mg morphine (n = 13). Treatment effect was measured in units on a 0 to 2 visual scale. By t test, butorphanol is more effective within 2 minutes than meperidine for suppressing shaking alone (P less than .02) or shaking among patients also complaining of pain (P less than .02). Morphine does not relieve shaking. The chi 2 test indicates women suppress PS more rapidly than men (P less than .01), and PS develops within 5 minutes of PACU arrival (P less than .001). Findings suggest that butorphanol is an alternative PS treatment to meperidine, since it relieves shaking within 2 to 5 minutes without producing nausea, vomiting, or recurrence of shaking.
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PMID:Butorphanol tartrate (Stadol) relieves postanesthesia shaking more effectively than meperidine (Demerol) or morphine. 157

Mental and psychomotor abilities are impaired to varying degrees after general anaesthesia. This has important implications for the time over which patients are monitored in the recovery room and for the discharge of outpatients after day surgery. The present study was undertaken to compare recovery and mental and psychomotor skills in the first 60 min following general anaesthesia with isoflurane, midazolam/alfentanil and propofol. METHODS. A total of 45 patients undergoing microsurgical lumbar nucleotomy were randomized to three study groups. Group 1 (n = 15): anaesthesia was induced with thiopentone and maintained with isoflurane; group 2 (n = 15): anaesthesia was induced with midazolam and maintained with alfentanil; group 3 (n = 15): anaesthesia was induced and maintained with propofol. Vecuronium was used for muscle relaxation and the lungs were ventilated with a mixture of 66% nitrous oxide in oxygen. The following were checked 15, 30, 45, and 60 min after extubation: choice reaction times and critical flicker fusion for psychomotor testing; the maze test and a modification of the ball-bearing test for discrimination of motor and mental activities; and short- and long-term memory. RESULTS. Immediate recovery did not differ in the three different groups. In all patients psychomotor function was impaired compared with baseline for more than 60 min after general anaesthesia. However, impairment was significantly less pronounced after propofol, and recovery to preanaesthesia values was faster following propofol than after midazolam/alfentanil, and slowest after isoflurane-anaesthesia (Figs. 1, 2). The flicker fusion frequency, a very sensitive parameter for the persisting effects of anaesthetics, was significantly higher following propofol anaesthesia and remained so throughout the entire study period (Fig. 3). By 30 min after extubation, short-term memory was already normal in patients who had undergone propofol anaesthesia, and a statistically significant difference from the midazolam/alfentanil and isoflurane anaesthesia groups was obvious throughout the entire study period. However, no differences in long-term memory were found. At 30 min after propofol anaesthesia all patients were able to perform the ball-bearing test, as against 13 patients following midazolam/alfentanil and 10 patients following isoflurane (Table 3). The maze test was mostly impaired after midazolam/alfentanil anaesthesia. Patients who underwent isoflurane anaesthesia needed the same time for the maze test at 60 min afterwards propofol patients needed after 30 min (Table 2). Side effects, e.g., nausea, vomiting, and double vision, were observed significantly more often in groups 1 and 2 (Table 4). DISCUSSION AND CONCLUSION. The results indicate that in operations of approximately 90 min duration the return of motor and mental abilities is faster following propofol anaesthesia. At 30 min after extubation following propofol anaesthesia patients had test results that allow their transfer from the recovery room, while it took 60 min for patients in the two other groups to reach the same levels of motor and mental function. This is important for the duration of monitoring in the recovery room and, especially, for day case anaesthesia.
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PMID:[Cognitive and psychomotor performance following isoflurane, midazolam/alfentanil and propofol anesthesia. A comparative study]. 159 May 75

While the number of patients at risk for vomiting and aspiration has been reported to be high, the incidence of clinically important pulmonary aspiration is low. We sought to define the incidence of gastroesophageal reflux (GER) and to correlate this with the clinical variables of obesity, history of oesophagitis, bucking and changes in body position. Continuous oesophageal pH measurement was used to determine the frequency of gastroesophageal reflux in 44 patients having general anaesthesia for elective surgical procedures. Acid reflux to a pH value of less than four occurred in seven patients (15.9%) during anaesthesia. This was associated temporally with straining on the endotracheal tube in six subjects (13.6%). We conclude that traditional risk factors are not always predictive of those patients at risk of regurgitation and aspiration.
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PMID:Gastroesophageal reflux during anaesthesia. 159 71

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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