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)

During propofol-nitrous oxide (N2O) anesthesia, volatile anesthetics are frequently administered to treat signs of inadequate anesthesia and to decrease the possibility of intraoperative awareness. Because the clinical effects of this combination have not been examined rigorously, we used data from the 1989-90 Phase IV clinical trial with propofol to evaluate recovery from propofol-N2O anesthesia with and without supplementation with isoflurane. In this study involving 15,806 patients at 1722 institutions, propofol was administered for induction and maintenance of anesthesia with N2O for procedures lasting less than 60 min. At the discretion of the anesthesiologist, volatile anesthetics were administered as needed during maintenance of anesthesia (the incidence of use of inhaled anesthetics was 14.7% for isoflurane, 2.2% for enflurane, and 0.2% for halothane). Other intraoperative medications included opioid analgesics, muscle relaxants, and anticholinergic drugs. The present study concerns the subset of 7796 patients given propofol-N2O maintenance anesthesia (intermittent bolus or continuous infusion) with or without isoflurane supplementation for procedures lasting less than 60 min. Isoflurane was used more frequently for procedures lasting 30-60 min than for those less than 30 min. Nevertheless, the maintenance dose of propofol was significantly (P < 0.05) less with isoflurane (178 vs 235 mg). Adjunctive use of isoflurane prolonged the time to awakening and to becoming oriented, but discharge times were similar for the two groups. The incidence of postoperative nausea, vomiting, recall, and excitement did not differ between the two groups. We conclude that the addition of isoflurane to a propofol-N2O anesthetic does not alter recovery from anesthesia.
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PMID:Effects on recovery when isoflurane is used to supplement propofol-nitrous oxide anesthesia. 821 92

Propofol anaesthesia may reduce postoperative emesis. The purpose of this study was to compare the incidence of emesis after propofol anaesthesia with and without nitrous oxide, compared with thiopentone and halothane anaesthesia, in hospital and up to 24 hr postoperatively, in outpatient paediatric patients after strabismus surgery. Seventy-five ASA class I or II, unpremedicated patients, aged 2-12 yr were randomly assigned to one of three groups: Thiopentone, 6.0 mg.kg-1 i.v. induction followed by halothane and N2O/O2 for maintenance (T/H); propofol for induction, followed by propofol and oxygen for maintenance (P/O2); and propofol for i.v. induction, followed by propofol infusion and N2O/O2 for maintenance (P/N2O). All received vecuronium, controlled ventilation, and acetaminophen pr. Morphine was given as needed for postoperative analgesia. There were no differences in age, weight, number of eye muscles operated upon, duration of anaesthesia or surgery. The P/N2O group (255 +/- 80 micrograms.kg-1 x min-1) received less propofol than the P/O2 group (344 +/- 60 micrograms.kg-1 x min-1) (P < or = 0.0001) and had shorter extubation (P < 0.001) and recovery (P < 0.01) times. Emesis in the hospital, in both the P/N2O (4.0%) and P/O2 group (4.0%) was less than in the T/H group (32%) (P < 0.01). Antiemetics were required in four patients in the T/H group (16.0%). Overall emesis after surgery was not different among the groups: T/H (48%), P/O2 (28%) and P/N2O (42%). The use of propofol anaesthesia with and without N2O decreased only early emesis. This supports the concept of a short-acting, specific antiemetic effect of propofol.
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PMID:Propofol anaesthesia reduces early postoperative emesis after paediatric strabismus surgery. 822 31

In children, strabismus surgery is frequently followed by vomiting. The present study compares the antiemetic effects of droperidol (10 micrograms/kg) and/or metoclopramide (0.1 mg/kg) in 104 children undergoing strabismus surgery. The patients were randomly divided into four groups. Group I (n = 28) received placebo (saline), Group II (n = 26) droperidol 10 micrograms/kg, Group III (n = 25) metoclopramide 0.1 mg/kg and Group IV (n = 25) droperidol 10 micrograms/kg and metoclopramide 0.1 mg/kg. Droperidol was given just after induction and metoclopramide at the end of surgery, just before recovery. The technique of anesthesia involved an anticholinergic premedication, IV fentanyl (2 micrograms/kg), controlled ventilation using isoflurance and N2O in oxygen and systematic gastric emptying before extubation. Vomiting, retching and nausea were noted at 5 different moments: in the Post Anesthetic Care Unit, when arriving on the ward (= after carriage by lift), during the first hour following the return in the ward, from the 6th to the 12th postoperative hour and on the morning of day 1. There was no statistically significant difference in the incidence of vomiting among these four groups. Moreover, the incidence of vomiting in the placebo group was much lower (17.9% in the recovery room, 3.6% at return in the ward, 25% during the first hour, 7.1% from 6 to 12 hours and 3.6% the next day) than that reported in previous studies. We think that this could result from the additive effects of some aspects of the technique of anesthesia described and discussed in this paper.
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PMID:Open placebo controlled comparison of the antiemetic effect of droperidol, metoclopramide or a combination of both in pediatric strabismus surgery. 834 2

All obtainable investigations that have compared the incidence of vomiting in groups of patients who received nitrous oxide (N2O) and in patients who received anesthetics or analgesics without N2O were examined for a single, dichotomous variable: whether patients who received N2O experienced an absolutely higher incidence, as distinct from a statistically significantly higher incidence, of vomiting. The null hypothesis is that N2O has no effect on emesis, such that an increased incidence of vomiting should occur in about half of the studies examined. However, patients receiving N2O experienced an absolutely higher incidence of emesis in 24 of 27 investigations. The two-tailed probability that this result occurred by chance is < 0.00005. It follows that N2O increases the incidence of emesis compared to alternative anesthetics.
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PMID:Twenty-four of twenty-seven studies show a greater incidence of emesis associated with nitrous oxide than with alternative anesthetics. 980 20

Two anaesthetic managements for elective laparoscopic cholecystectomy were compared in 64 patients in order to investigate some perioperative complications: 1) bowel distension during surgery. 2) recovery from anaesthesia. 3) post-surgery incidence of emesis and pain. In addition, the quality of postoperative peristalsis as well as the time of dimissal were recorded. Group I (n = 30) was treated with NLA in N2O-O2 and Group II (n = 34) received propofol plus fentanyl in air-O2. Bowel distension, evaluated by surgeon at 15 min intervals throughout the operation was similar in both the groups as well as postoperative peristalsis recuperation. During the first 12 hours after laparoscopy no differences were found at any times of observation in the incidence or severity of emesis and pain between the two different anaesthesia patients. In subjects which were given propofol the psychomotor recovery was more rapid than after NLA, particularly during the first 6 hours after surgery. The patients were discharged between 36-48 hours following the operation independently from anaesthetic management. It is concluded that both the anaesthetic techniques provide similar intra/postoperative conditions, except the early recovery that is more rapid for the propofol patients. The overall frequency of emesis and pain was rather high in both the groups, suggesting a routine medication with analgesics and antiemetics.
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PMID:[Laparoscopic cholecystectomy: evaluation of intraoperative complications with respect to 2 different kinds of anesthesia]. 868 33

Both intravenous ondansetron (OND) and droperidol (DROP) have been observed to reduce vomiting after tonsillectomy in children. This randomized, double-blind investigation compared the effect of OND and DROP on vomiting after outpatient tonsillectomy in 276 healthy children age 2-12 yr. All subjects received a standardized anaesthetic, which consisted of induction with either propofol or halothane/N2O, vecuronium 0.1 mg x kg(-1) on an as needed basis, maintenance with halothane/N2O, midazolam and codeine, and reversal of neuromuscular blockade with neostigmine and atropine on an as needed basis. Subjects were given either OND 150 micrograms x kg(-1) or DROP 50 micrograms x kg(-1)iv after induction of anaesthesia. Rescue antiemetics in the hospital were administered to patients who vomited X 2 and X 4, respectively. Postoperative pain was treated with morphine, codeine and/or acetaminophen. For 24 hr following surgery, emesis was recorded by nursing staff while subjects were in the hospital, and by parents following discharge from hospital. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. The frequency of in-hospital emesis was 16% in the OND-patients and 30% in the DROP-group, P <0.05. The OND-subjects required fewer rescue antiemetics, 5% vs 13%, P <0.05. The overall incidence of emesis was 45% in the OND-group and 57% in the DROP-group, P <0.05. In conclusion, ondansetron was a superior prophylactic antiemetic for tonsillectomy in children when compared to droperidol.
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PMID:Ondansetron is a better prophylactic antiemetic than droperidol for tonsillectomy in children. 870 91

We have reviewed randomized controlled trials to assess the effectiveness and safety of anaesthetics which omitted nitrous oxide (N2O) to prevent postoperative nausea and vomiting (PONV). Early and late PONV (6 and 48 h after operation, respectively), and adverse effects were evaluated using the numbers-needed-to-treat (NNT) method. In 24 reports with information on 2478 patients, the mean incidence of early and late vomiting with N2O (control) was 17% and 30%, respectively. Omitting N2O significantly reduced vomiting compared with a N2O regimen; the combined NNT to prevent both early and late vomiting with a N2O-free regimen was about 13 (95% confidence intervals (CI) 9, 30). The magnitude of the effect depended on the incidence of vomiting in controls. In studies with a baseline risk higher than the mean of all reports, the NNT to prevent both early and late vomiting with a N2O-free anaesthetic was 5 (95% CI 4, 10). When the baseline risk was lower than the mean, omitting N2O did not improve outcome. Omitting N2O had no effect on complete control of emesis or nausea. The NNT for intraoperative awareness with a N2O-free anaesthetic was 46 compared with anaesthetics where N2O was used. This clinically important risk of major harm reduces the usefulness of omitting N2O to prevent postoperative emesis.
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PMID:Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. 877 95

Sixty ASA I and II patients scheduled for laparoscopic cholecystectomy or inguinal herniotomy were randomly assigned to one of two groups: Group one (n = 30): induction with thiopentone 4-6 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with halothane (0.8-1.5%), and N2O in O2 (FiO2 = 0.33). Group two (n = 30): induction with propofol 2-3 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with propofol 6-10 mg kg-1 h-1, and O2 in N2 (FiO2:0.33). Seven of the patients experienced nausea in each group with group one having higher emetic scores. Six patients in group one vomited compared to none in group two (P < 0.05). The overall incidence of emetic sequelae (nausea or vomiting) was 43% in group one and 23% in group two (P = 0.17). Patients with propofol anaesthesia had lower emetic scores and higher recovery scores compared with those after thiopentone/halothane anaesthesia.
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PMID:Nausea and vomiting after laparoscopic surgery: a comparison of propofol and thiopentone/halothane anaesthesia. 882 33

We evaluated the effect of dexamethasone on vomiting after elective tonsillectomy in 133 healthy children aged 2-12 yr in a randomized, stratified, blocked, double-blind, placebo-controlled study. General anesthesia was induced by inhalation of N2O and halothane or intravenously (IV) with propofol. Anesthesia was maintained with N2O and halothane. Dexamethasone 150 micrograms/kg up to a maximum dose of 8 mg, or placebo, was administered IV before surgery. All patients received 1.5 mg/kg codeine intramuscularly (IM) intraoperatively. Perioperative IV fluids, management of emesis, postoperative pain and hospital discharge criteria were all standardized. The groups were similar with respect to number, age, weight, length of surgery, and estimated intraoperative blood loss. Dexamethasone reduced the overall incidence of vomiting from 72% (placebo) to 40% (P < 0.001). Vomiting, both in-hospital and postdischarge, was decreased by the prophylactic administration of dexamethasone. Each episode of in-hospital vomiting prolonged discharge by 13 +/- 2 min, mean +/- SD (P < 0.001). In conclusion, dexamethasone markedly decreased vomiting by healthy children after elective tonsillectomy in an ambulatory hospital setting.
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PMID:Dexamethasone decreases vomiting by children after tonsillectomy. 889 62

This study compares the emergence and recovery characteristics of sevoflurane, desflurane, and halothane in children undergoing adenoidectomy with bilateral myringotomy and the insertion of tubes. Eighty children 1-7 yr of age were studied. Thirty minutes prior to the induction of anesthesia, all patients received 0.5 mg/kg midazolam orally. Patients were randomly assigned to one of four groups: Group 1, sevoflurane induction and maintenance (S:S); Group 2, halothane induction and sevoflurane maintenance (H:S); Group 3, halothane induction and maintenance (H:H); or Group 4, halothane induction and desflurane maintenance (H:D). Tracheal intubation was facilitated with the use of a single dose of 0.2 mg/kg mivacurium. A Mapelson D circuit was used, and all patients received N2O:O2 60:40 for induction and maintenance at standardized appropriate fresh gas flow. Ventilation was controlled to maintain normocapnia. End-tidal concentration of anesthetics was maintained at approximately 1.3 minimum alveolar anesthetic concentration (MAC) (halothane: 0.56; sevoflurane: 2.6; desflurane: 8.3) until the end of surgery when all anesthetics were discontinued. Emergence (extubation), recovery (Steward score 6), and discharge times were compared among patients in the four groups using analysis of variance and Newman-Keuls tests P < 0.05 was considered significant. There were no significant differences among the four groups with respect to age, weight, duration of surgery, or duration of anesthesia. Emergence and recovery from anesthesia were significantly faster in the desflurane group (Group 4) compared with the sevoflurane and halothane groups (Groups 1, 2, and 3) (5 +/- 1.6 min vs 11 +/- 3.7, 11 +/- 4.0, 10 +/- 4.0 min and 11 +/- 3.9 min vs 17 +/- 5.5, 19 +/- 7.1, 21 +/- 8.5 min, respectively). There was a significantly greater incidence of postoperative agitation and excitement in patients who received desflurane (55%) versus sevoflurane (10%) and halothane (25%). There were no significant differences among the four groups with respect to the time to meet home discharge criteria (134 +/- 36.9, 129 +/- 53.3, 117 +/- 64.6, 137 +/- 22.6 in Groups 1, 2, 3, and 4, respectively), in the time to drink oral fluids (139 +/- 31.6, 136 +/- 53.8, 123 +/- 65.0, 142 +/- 29.4 min, respectively), or in the incidence of postoperative vomiting. It is concluded that, although desflurane resulted in the fastest early emergence from anesthesia, it was associated with a greater incidence of postoperative agitation. Sevoflurane resulted in similar emergence and recovery compared with halothane. Desflurane and sevoflurane did not result in faster discharge times than halothane in this patient population.
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PMID:Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. 889 63


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