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)

Labetalol, an alpha- and beta-adrenergic receptor-blocking agent, was studied as a hypotensive agent during halothane (mostly 0.5 vol.%)-N2O-fentanyl-d-tubocurarine anaesthesia with a head-up tilt of 5 degrees in 41 patients undergoing middle ear microsurgery. After the mean initial dose of 0.3 mg/kg, the mean need for labetalol ranged from 0.05 to 0.07 mg/kg at 30 +/- 5-min intervals. The mean duration of the hypotensive period was 102 min. During the hypotension, the average mean arterial pressure ranged from 59 to 62 mmHg (7.9-8.3 kPa) and the mean heart rate from 61 to 66 b.p.m. After labetalol the maximum cardiac output decrease was 7%. Before labetalol the mean PaO2 value was 158 mmHg (21.1 kPa) and during hypotension it ranged from 145 to 149 mmHg (19.3-19.9 kPa) when FiO2 was 40%. The only peroperative side effects were ECG changes (middle junctional rhythm and sinus bradycardia) which occurred in 10% of the patients. The mean value for the degree of haemostasis rated by the otologist on a visual analogue scale between poor (0 mm) and excellent (100 mm) was 91 mm. The patients were able to open their eyes and to give their names 8-9 min after the end of anaesthesia. After extubation the patients were normotensive and there were no clinically significant changes in the cardiovascular parameters during the 4-h recovery room period. Acid-base status showed slight metabolic acidosis. The most common postoperative side effects were nausea only and nausea + vomiting, which occurred in 39% and 20% of the patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Labetalol as a hypotensive agent for middle ear microsurgery. 357 41

During a 2 year period nitrous oxide was used as a sole or supplementary analgesic during 173 vascular or interventional procedures including peripheral angiography and endourologic and endobiliary procedures. The decision to administer nitrous oxide to a given patient was a matter of physician preference. Patients with bowel obstruction, pneumothorax, or chronic obstructive pulmonary disease were excluded from this method of analgesia. The nitrous oxide was administered by a radiology nurse under the supervision of an attending radiologist. Nitrous oxide was used without premedication for 39 procedures and with premedication (usually meperidine 1 mg/kg, promethazine 0.3 mg/kg, or atropine 0.01 mg/kg) in 134 procedures. In 74% of nonpremedicated individuals analgesia was adequate with nitrous oxide alone; 26% required supplemental intravenous medication. In 61% of premedicated individuals pain relief was adequate with nitrous oxide; 39% required supplemental intravenous medication. Complications, including nausea, vomiting, and agitation, occurred in eight patients, but were minor and easily reversed by decreasing the concentration of nitrous oxide. Nasally administered nitrous oxide is a safe, easily used, and effective analgesic.
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PMID:Nitrous oxide: effective analgesic for vascular and interventional procedures. 387 37

The synthetic opioid tramadol was given to 40 patients during surgery according to a fixed, calculated infusion scheme. Anesthesia was started with thiopental and the patients were given different nitrous oxide concentrations via a semi-open system (group 1: 60%, group 2: 75%). The aim of this study was to clarify whether this anaesthetic procedure is practicable or whether it has grave disadvantages in comparison with the anesthesia models used so far. Furthermore we wanted to clarify whether under this infusion scheme the proportion of N2O in the inspiratory mixture is sufficient or whether higher concentrations are required. In 24 of 40 patients analgesia or the depth of anaesthesia was insufficient so that additional enflurane application was necessary. Postoperative respiratory depression in three patients had to be treated with naloxone. The advantages of this procedure are the safe and easy practicability, absence of significant changes in the haemodynamic parameters, good postoperative response of the patients and postoperative pain relief as well as the low incidence of postoperative side effects such as nausea, vomiting and CO2-retention.
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PMID:[Tramadol infusion anesthesia with the substitution of enflurane and various nitrous oxide concentrations]. 391 7

Alfentanil in combination with etomidate and N2O/O2 was given to 50 patients as single dosage (0.024 mg/kg b.w.) or with repeated injections for surgical interventions up to 90 minutes duration. In 68% of these cases sufficient analgesia was obtained. The most frequent side-effects were rigidity of the thorax (54%), quick, extensive changes in blood pressure (32%) and bradycardia (28%). The recovery phase was very short, postoperative sickness and vomiting were seen in 6% of all cases. Still, after repeated injections phases with prolonged sleep can appear. While using Alfentanil, exact monitoring is necessary, as quick and unexpected changes of blood pressure and pulse can appear.
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PMID:[Alfentanil in routine clinical use. A study of 50 patients]. 391 9

The antiemetic effect of clebopride, a new derivative of the orthopramide group, was compared with that of placebo in 298 women undergoing elective surgery. A group of 150 patients received premedication of 1 mg/kg of meperidine, administered intramuscularly (IM), and a group of 148 patients received premedication of 10 mg of diazepam IM. All patients received 0.5 mg of atropine IM. Anesthesia was induced with thiopental and maintained with halogenated N2O/O2. In a double-blind procedure, clebopride (2 mg) or placebo was injected IM at the end of anesthesia and whenever a patient had a second episode of vomiting. Clebopride appeared to be better than placebo in the prevention of nausea (P less than or equal to 0.05) and vomiting (P less than or equal to 0.001) during the 12-hour observation period. The frequency of side effects was virtually the same in patients given clebopride and patients given placebo.
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PMID:Effect of intramuscular clebopride on postoperative nausea and vomiting. 399 31

Systolic, diastolic blood pressures, heart rate, glycaemia, blood gases and clinical status were studied preinduction, 10' after anesthesia induction and intubation, 3', 30', 60' and 90' after surgical incision, when awake on the operating table and 60' after awakening in 20 hysterectomy patients. Etomidate (0.3 mg/kg + continuous infusion), alfentanil (75 micrograms/kg + increments of 15 micrograms/kg) anesthesia was used with a N2O/O2 mixture (10 pt) or with air/O2 (10 pt), both at a FIO2 = 0.33. This technique gave a smooth induction and recovery. Cardiovascular changes were moderate. The additional dose of alfentanil was 5.25 +/- 0.65 mg in the N2O/O2 group and 6.45 +/- 0.85 mg in the air/O2 group. The incidence of vomiting was 15%. Statistical analysis of both groups indicated no major difference between the two types of anesthesia, for the cardiovascular, acid base data and glycaemia. This technique is a simple and effective way of anesthetising patients, but from a clinical point of view the etomidate/alfentanil anesthesia combined with N2O/O2 gives better results than when combined with air/O2.
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PMID:Comparative study of etomidate-alfentanil anesthesia with N2O/O2 or with air/O2. 642 92

Postoperative vomiting is induced by different mechanisms such as age, anaesthetic technique and medications, postoperative analgesia, and surgical traction on the extra-ocular muscles. The influence of anticholinergic premedication and the use of benzodiazepines as factors affecting the incidence of vomiting is controversial. In a prospective, randomised, single-blind study we examined two different treatments with regard to postoperative pain, vigilance, and vomiting in young children undergoing strabismus repair. METHODS. After institutional ethical committee approval, informed written consent was obtained from all parents. The children were randomly assigned to three groups: (1) paracetamol (P)--17 patients who received 250-500 mg paracetamol rectally (dependent on body weight) immediately after intubation of the trachea; (2) bupivacaine (B)--17 patients who received two drops 0.5% bupivacaine hydrochloride on the conjunctiva of the eye(s) being corrected following intubation of the trachea and again 10 min after intubation. After the surgeon had exposed the extra-ocular muscle and before readaptation of the conjunctiva, two drops of the same solution were applied again each time directly on the muscle; and (3) controls (C)--16 patients who received rectal paracetamol after completion of the operation but before extubation. The children were premedicated with 0.05 mg/kg flunitrazepam sublingually. After 0.25 mg atropine i.v., anaesthesia was induced with 0.1 mg/kg vecuronium, 5 mg/kg thiopentone, 1.5 vol% enflurane, and N2O/O2 50:50. When the trachea was intubated anaesthesia was maintained with enflurane as required and 70% N2O in oxygen. Extubation was performed only if the patient could touch or did not tolerate the tube. Oral diet was allowed 6 h after extubation at the earliest. EXAMINATION OF VIGILANCE AND ANALGESIA. The degrees of vigilance and pain were evaluated preoperatively and after extubation over 24 h using two different scales. Evaluation of the scales was performed during the first 3 postoperative h at 12 different time points (Figs. 1, 2) and 6, 12, and 24 h after extubation. The evaluation was conducted by nursing staff who were blinded to the treatment (single-blind study). Postoperative analgesia consisted of 250-500 mg rectal paracetamol (all patients). Parametric data were expressed as mean +/- SD, and comparisons were made with the one-way analysis of variance. Fisher's exact test was applied to ordinal data. P < 0.05 indicates a statistically significant difference. RESULTS. Two patients (P) were excluded from the study postoperatively because of refusing rectal paracetamol in spite of pain and postoperative infection of the upper airways, which had manifested on the afternoon of the operative day. No significant differences were found between the three groups in patient characteristics (Table 1). The quantity of enflurane administered, rate, postoperative consumption of rectal paracetamol, and postoperative emesis were highest in the control group (Tables 2, 3), but the incidence of postoperative vomiting ranged only between 13% and 24% (Table 3). Children with preoperative paracetamol needed more time to fulfill the criteria to "stick out the tongue" and "recognising the mother". VIGILANCE. The time to postoperative crying or screaming and restlessness was shorter in the control group. The values reached significant difference at 10 min (P) and 25 min (P and B) after extubation compared with the other groups (Fig. 1). ANALGESIE. At 5, 10, and 150 min after extubation pain was significantly higher in patients in the control group (Fig. 2). CONCLUSIONS. Intraoperative administration of rectal paracetamol or topical 0.5% bupivacaine was most effective in the treatment of postoperative pain for strabismus surgery in younger children. Sublingual flunitrazepam and i.v. atropine given as premedication probably decrease postoperative vomiting.
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PMID:[Strabismus surgery in children. The effect of paracetamol and bupivacaine]. 761 77

Sevoflurane, a new volatile anesthetic agent, is of great potential interest in pediatric anesthesia. Its use for ENT surgery in children was compared with halothane in this study. Altogether 40 children participated in the investigation. In 18 (median age 4.2 years), halothane was used. The remainder (median age 4.0 years) were anesthetized with sevoflurane. After rectal premedication with midazolam and atropine, anesthesia was induced by mask (the agent in O2/N2O, 40/60) using a Mapleson D system. The trachea was intubated without the use of muscle relaxants and the children were then allowed to breathe spontaneously at fresh gas flows set high enough to avoid rebreathing. Hemoglobine oxygen saturation (SpO2), inspired and expired gas concentrations, respiratory rate (RR), heart rate (HR), ECG and blood pressure were followed. Equianesthetic concentrations of the agents were used and induction characteristics were comparable between the two agents. RR and end-tidal CO2 tensions were similar in the two groups. HR and systolic blood pressures were, however, higher with sevoflurane. Cardiac arrhythmias were seen more frequently with halothane (61%) than with sevoflurane (5%). During emergence, postoperative nausea/vomiting was more frequent after halothane anesthesia. Initially, postoperative excitement occurred more often after sevoflurane, when paracetamol was given during anesthesia, which was reduced (P < 0.01) when paracetamol was given at the time for premedication. It is concluded that sevoflurane is an excellent induction agent, and maintains heart rate and systolic blood pressure better than when halothane is used. The incidence of cardiac arrhythmia is lower with sevoflurane than with halothane.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sevoflurane for ENT-surgery in children. A comparison with halothane. 767 95

The purpose of this study was to compare the effect of local anaesthesia (LA) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, single-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with N2O/O2 and halothane or propofol and maintained with N2O/O2/halothane. Local anaesthesia included ilioinguinal and iliohypogastric nerve block plus subcutaneous injection by the surgeon of up to 0.3 ml.kg-1 bupivacaine 0.25% with 5 micrograms.kg-1 adrenaline. The dose for caudal anaesthesia was 1 ml.kg-1 up to 20 ml bupivacaine 0.2% with 5 micrograms.kg-1 adrenaline. Postoperative pain was assessed with mCHEOPS in the anaesthesia recovery room, with postoperative usage of opioid and acetaminophen in the hospital, and with parental assessment of pain with a VAS. Vomiting, time to first ambulation and first urination were recorded. The postoperative pain scores and opioid usage were similar; however, the LA-group required more acetaminophen in the Day Care Surgical Unit. The incidence of vomiting and the times to first ambulation and first urination were similar. The LA-patients had a shorter recovery room stay (40 +/- 9 vs 45 +/- 15 min, P < 0.02). The postoperative stay was prolonged in the CA group (176 +/- 32 vs 165 +/- 26 min, P = 0.02). We conclude that LA and CA have similar effects on postoperative care with only slight differences.
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PMID:Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia. 774 68

The aim of this study was to establish whether nitrous oxide has a clinically important effect on postoperative vomiting in children after myringotomy. We studied 320 healthy children of ages 0.5-13 yr undergoing elective myringotomy and tube insertion. Induction and maintenance of anaesthesia were randomized to inhalation with either 70% N2O/30% O2/halothane or 100%O2/halothane. Surgical technique and postoperative management were not influenced by this study. Vomiting in the recovery room (PAR) and Day Care Surgical Unit (DCSU) was recorded by nurses unaware of the anaesthetic technique. Parents were contacted 24-48 hr after surgery to ascertain the incidence of vomiting after discharge. The groups were similar with respect to demographic data, except that the anaesthesia time was greater among the 158 patients in the N2O-treated group (11 +/- 4 vs 12 +/- 4 min, mean +/- SD). The incidence of vomiting was 13% in both groups. Most of the 42 patients that had emesis only vomited once or twice. The incidence of vomiting was not altered by sex (13% vs 13%) or duration of anaesthesia. The incidence of vomiting increased with increasing age. The children aged less than 3 yr vomited 4% of the time, those aged 3-5 vomited 11% of the time, those aged 6-8 yr vomited 17% of the time, while the incidence of vomiting among those aged 9-13 yr was 31%. Vomiting prolonged the postoperative hospital stay from 75 to 92 min, P < 0.001, ANOVA. In summary, we have been unable to demonstrate that N2O induces vomiting by children after a brief general anaesthetic for myringotomy.
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PMID:Nitrous oxide does not increase vomiting in children after myringotomy. 778 20


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