Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Maximizing patient safety and comfort while minimizing adverse sequelae are continuing anesthetic challenges. The purpose of this study was to examine three anesthetic techniques utilizing alfentanil with regard to time to awakening, time to orientation and incidence of nausea and vomiting. Surgical procedures were limited to knee arthroscopy, laparoscopy and dental extractions. Unpremedicated ASA I/II outpatients (n = 74) between the ages of 18 and 59 were randomly assigned to one of three groups: Group I: alfentanil + 67% N2O + 33% O2 Group II: alfentanil + 67% N2O + 33% O2 + droperidol 0.015 mg/kg Group III: alfentanil + 100% O2 + 0.7% isoflurane Anesthesia was induced with alfentanil 40 micrograms/kg, atracurium 0.4 mg/kg, thiamylal 4 mg/kg and 100% O2 and was maintained according to group assignment. The anesthetic was supplemented as clinically indicated with incremental boluses of alfentanil 10 micrograms/kg. Upon completion of surgery, muscle relaxation was reversed with edrophonium 0.75 mg/kg and atropine 0.015 mg/kg. Analyses indicated that the three groups were comparable in terms of potentially confounding variables including gender, race, surgical procedure, age, percent of ideal body weight, case length and dose of alfentanil in micrograms/kg/hr. Time to awakening was significantly shorter in the two N2O groups by approximately 1.5 minutes, as compared to the O2 and isoflurane group (p = .0060). Time to orientation was significantly shorter in the N2O groups by approximately 1.5 minutes also, as compared to the O2 and isoflurane group (p = .0142). The two N2O groups did not differ significantly in either measure. The incidence of vomiting in the postanesthesia recovery room (PARR) indicated a significant difference (p = .0317) among groups with vomiting occurring 45.8% of the time in Group I, 28.8% of the time in Group II and 8% of the time in Group III. Total emetic score (nausea and vomiting) in the PARR indicated a significant difference (p = .03) among groups with symptoms occurring 50% of the time in Group I, 28% of the time in Group II, and 16% of the time in Group III.
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PMID:Comparison of three techniques on time to awakening, time to orientation and incidence of nausea and vomiting using alfentanil in balanced anesthesia in an outpatient surgical setting. 237 39

This randomized, double-blind study evaluated the efficacy of metoclopramide administered at the completion of surgery as an antiemetic agent in pediatric patients undergoing ambulatory strabismus surgery; 126 unpremedicated ASA Physical Status 1 and 2 children ranging in age from 2 to 18 yr served as subjects. All received general anesthesia with halothane, N2O, and O2; tracheal intubation was facilitated with intravenous (iv) atracurium 0.5 mg/kg. Intravenous atropine 0.02 mg/kg and lactated Ringer's solution with 5% dextrose equivalent to 4 h of maintenance fluids were administered during surgery. Neither opioids nor droperidol were given intraoperatively. At the completion of surgery, residual muscle paralysis was reversed with atropine 0.02 mg/kg (maximum dose 1.0 mg) and neostigmine 0.07 mg/kg (maximum dose 5.0 mg), and the stomach was decompressed prior to tracheal extubation. After the patient had been transferred to the postanesthesia recovery room (PARR) either metoclopramide 0.15 mg/kg or normal saline was administered intravenously to the children over a 1-min period. A research associate monitored the children for the incidence of post-operative vomiting and the time required for each child to meet discharge criteria from Short Stay Recovery Unit (SSRU). If a child vomited more than three times in both the PARR and SSRU, the vomiting was construed to be severe and the patient was offered further antiemetic treatment with iv droperidol 70 micrograms/kg. The incidence of postoperative vomiting in the metoclopramide group was 37% versus 59% in the placebo group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Metoclopramide reduces the incidence of vomiting following strabismus surgery in children. 240 36

Alfentanil mask anaesthesia was performed in 63 patients undergoing termination of pregnancy or curettage. Three different types of premedication were used: a) pethidine, promethazine, and atropine; b) diazepam and atropine; c) atropine. The patients were ventilated either with nitrous oxide and oxygen or with halothane and oxygen. Halothane reduced the frequency of muscular rigidity (32%; N2O 75%), postoperative sickness, and vomiting (23%; N2O 50%). On the other hand, patients regained consciousness earlier if nitrous oxide was used. Premedication a) also reduced the frequency of nausea and emesis (21%; other premedications 63%).-Alfentanil intubation anaesthesia was performed in 52 patients undergoing laparoscopy. Premedication and inhalation anaesthetic varied as described above in the group with mask anaesthesia. Muscular rigidity did not occur, and nausea/emesis were rare events (8%). Halothane prolonged the recovery phase of consciousness and respiration. Premedication a) also resulted in respiratory depression.
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PMID:[Influence of various premedication agents, inhalation anesthetics and adjuvants on anesthesia with an opioid, alfentanyl]. 286 27

To evaluate nasally administered sufentanil, 1.5-4.5 micrograms/kg, for pre-induction (i.e., pre-medication/induction) of anesthesia in pediatric patients, the authors studied ASA PS 1 or 2 patients scheduled for elective surgery. Eighty children, ages 6 months to 7 yr, were randomized to receive sufentanil (1.5, 3.0, or 4.5 micrograms/kg) or placebo (normal saline, 0.03 ml/kg) nasally over 15-20 s. Induction of anesthesia was completed with 5% halothane and O2 via facemask. After tracheal intubation, anesthesia was maintained with N2O (60-70%) and halothane, as clinically indicated. A blinded observer remained with the child from prior to drug administration until discharge from the recovery room. Patients given sufentanil were more likely to separate willingly from their parents and be judged as calm at or before 10 min compared to those given saline. Ventilatory compliance during induction of anesthesia decreased markedly in 25% of subjects given sufentanil, 4.5 micrograms/kg. Subjects given sufentanil moved or coughed less during tracheal intubation and required less halothane compared to those given placebo. During recovery, patients given sufentanil cried less and fewer needed analgesics; recovery times were similar for all groups. However, patients given sufentanil, 4.5 micrograms/kg, had a higher incidence of vomiting in the recovery room and during the first postoperative day. The authors conclude that nasally administered sufentanil, 1.5 or 3.0 micrograms/kg, facilitates separation of children from parents, has minimal side effects, may improve intubating conditions, and can provide postoperative analgesia.
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PMID:Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. 289 72

Sufentanil as a supplement to halothane/N2O anaesthesia was evaluated in 32 unpremedicated infants and children age 6 months to 9 yr undergoing elective orthopaedic surgery. Patients were randomly assigned in a double-blind manner to receive one of four intravenous supplements: placebo, sufentanil 0.5, 1.0 or 1.5 micrograms.kg-1. Systolic arterial pressure (SAP), heart rate (HR) and end-tidal halothane concentration were recorded before and after induction, supplement administration, tracheal intubation, incision and every 15 min during the procedure. Venous catecholamine samples were obtained before and after incision. A pain score was assigned to the patients in the postanaesthesia care unit (PACU). Sufentanil at all three doses prevented increases in SAP and HR with intubation and incision, provided superior pain relief in the PACU and did not prolong wake-up time. Sufentanil 1.0 and 1.5 micrograms.kg-1 allowed for a reduction in the halothane requirements. Sufentanil 1.5 micrograms.kg-1 was associated with lower catecholamine levels than in the placebo group following incision. Sufentanil supplementation at 1.0 and 1.5 micrograms.kg-1 was associated with bradycardia and/or hypotension during induction and an increased incidence of vomiting during the first 24 hours postoperatively. One patient in the sufentanil 1.0 micrograms.kg-1 group whose surgical time was less than 45 min exhibited respiratory depression in the PACU requiring narcotic reversal. In conclusion, sufentanil 0.5 micrograms.kg-1 improved immediate postoperative pain relief and is acceptable as a supplement during halothane anasethesia in infants and children. The associated side effects of larger doses of sufentanil (1.0 and 1.5 micrograms.kg-1) make their use as a supplement to halothane anaesthesia unacceptable.
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PMID:Low-dose sufentanil as a supplement to halothane/N2O anaesthesia in infants and children. 290 84

Nitrous oxide/oxygen has long been the mixture of gases used in dental practice to produce light sedation. The main indication for use of nitrous oxide/oxygen sedation is fear-anxiety. The equipment used is a continuous flow machine with a fail safe system set at a minimum of 30 or 40 per cent oxygen. A standardized sedation technique starting with administration of 100 per cent oxygen, is recommended. The concentration of nitrous oxide is then slowly increased and individually set, mostly between 30 and 50 per cent. In most cases the analgesia produced by nitrous oxide is not sufficient to ensure pain-free dental treatment. The sedation must therefore be supplemented by local anaesthesia. Side effects, e.g. restlessness, vomiting, and nausea are infrequent. About 90 per cent patients, who have difficulty in co-operating during dental treatment, mainly because of anxiety, show excellent or fair co-operation during nitrous oxide/oxygen sedation. Occupational exposure to nitrous oxide can be minimized by the use of scavenging systems, local exhaust systems, careful sedation technique, and equipment management.
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PMID:Sedation by the use of inhalation agents in dental care. 305 46

In two prospective, randomized studies the frequency of headache, nausea, vomiting, and analgesic requirement during the first postoperative 24 h was observed in order to study differences between the sexes and the inhalation anesthetics halothane, enflurane, isoflurane, or balanced anesthesia with enflurane/alfentanil. Nausea and vomiting were more frequent after enflurane than after halothane or isoflurane. There was no significant difference between anesthetics and frequency of headache, but there were significant differences in postoperative analgesic requirements which were highest after halothane and lowest after isoflurane. Postoperative complaints were always significantly greater among women than among men. The second study indicated that balanced anesthesia did not reduce the analgesic requirement compared to enflurane without alfentanil, but lead to a higher incidence of vomiting. After premedication with flunitrazepam and atropine and combined with 70% N2O/30% O2, isoflurane was the most favorable anesthetic agent with regard to the parameters studied. Balanced anesthesia with enflurane/alfentanil did not show any advantages for patients in the postoperative phase under the given conditions.
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PMID:[Complaints in the postoperative phase related to anesthetics]. 314 31

The study was designed to compare the frequency and severity of postoperative vomiting in paediatric out-patients receiving controlled ventilation (IPPV) or breathing spontaneously (SV) during anaesthesia for strabismus repair. One hundred and twenty unpremedicated children (ages 2-12 years) were studied in a randomized fashion. After intravenous induction of anaesthesia and tracheal intubation, patients breathed halothane 1-1.5 per cent inspired and N2O 66 per cent in O2 spontaneously (n = 60), or received IPPV, halothane 0.5-1 per cent, N2O 66 per cent, and pancuronium 0.05 mg.kg-1, which was reversed with neostigmine and atropine (n = 60). The incidence of vomiting with SV was 50 per cent (95 per cent confidence limits: 34.5-65.5 per cent) compared with 40 per cent (24.5-55.5 per cent) with IPPV (p greater than 0.25). Patients in the SV group experiencing emesis had longer operations than those not vomiting (mean +/- SEM = 1.5 +/- 0.1 vs 1.2 +/- 0.1 hours, p less than 0.005). This was not the case with IPPV. There was no correlation between age, sex, duration of surgery, or number of extraocular muscles repaired, and frequency or severity of vomiting or time to discharge. No significant advantage was afforded by IPPV over SV in the present study.
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PMID:Postoperative vomiting following strabismus surgery in paediatric outpatients: spontaneous versus controlled ventilation. 328 Jan 48

A total of 110 patients undergoing elective abdominal hysterectomy were anesthetized in random order with either isoflurane in nitrous oxide and oxygen or isoflurane in air and oxygen. Fentanyl was used as an adjunct to isoflurane in all patients, 0.05 mg every 45 min. No difference was found between the two anesthetic techniques in the incidence of nausea, vomiting, or both during the first 24 hr after operation. The overall incidence was 62 and 67% for air-O2 and N2O-O2 groups, respectively. Patients who had had nausea or vomiting after previous anesthetics had nausea or vomiting significantly more frequently than patients who did not. It is concluded that nitrous oxide does not contribute to the occurrence of nausea or vomiting after isoflurane anesthesia for gynecologic laparotomies.
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PMID:Nitrous oxide does not increase the incidence of nausea and vomiting after isoflurane anesthesia. 330 Apr 26

Transdermal scopolamine has already proved an effective premedication to prevent postoperative nausea and vomiting. In a double-blind study, the effects and above all the side effects of TTS-scopolamine (TTS-s) and TTS-placebo (TTS-p) were investigated in elderly patients (greater than 50 years), who are particularly susceptible to adverse drug reactions. The 59 (out of 61) male and female patients who could finally be evaluated had to undergo long (1-6.3 hrs.) surgical or gynaecological interventions in general anaesthesia after premedication with benzodiazepines in the evening and in the morning. The operations were performed under intubation anaesthesia induced by barbiturate (3-5 mg/kg bw) or etomidate (0.2-0.3 mg/kg bw), together with enflurane (0.5-2.5 vol.%) or isoflurane (0.5-1.5 vol.%), N2O/O2 (2:1) and fentanyl (0.05-0.45 mg). Alcuronium or vecuronium were given for relaxation, pyridostigmine/atropine was administered for antagonisation. The patient groups did not differ significantly with regard to age (mean = 65 years vs. 63 years), sex, height, weight, concomitant diseases, method and duration of operation, method and duration of anaesthesia, postoperative antagonisation and analgesia. In patients under TTS-s postoperative nausea was less intensive and of shorter duration. In contrast to 7 patients of the placebo group (p less than 0.05), no case of vomiting could be observed in the TTS-s group. The efficacy of TTS-s was significantly better than that of TTS-p. TTS-s and TTS-p were both tolerated equally well. In both groups, the most frequent side effect was dryness of the mouth, but without any significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effects and side effects of transdermal scopolamine for premedication in general anesthesia in elderly patients]. 354 38


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