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Fulltext Post-colonoscopy diverticulitis: A systematic review

Ng ZQ, Tan JH, Tan HCL, Theophilus M

World J Gastrointest Endosc, 2021 Mar 16;13(3):82-89.
PMID: 33763188 DOI: 10.4253/wjge.v13.i3.82

BACKGROUND: Post-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature.
AIM: To systematically review all available evidence to describe the incidence, clinical course with management and propose a definition.
METHODS: The databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes.
RESULTS: A total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention (i.e., antibiotics and bowel rest).
CONCLUSION: The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.

Matched MeSH terms: Nausea
Fulltext Application of occupational health surveillance program among responder’s during chemical incident at Pasir Gudang, Johor

Salvaraji L., Haidar R.T., Mohd Aris N., Ayob Q. A., Nordin N., Abdul Latif N., et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):29-29.
MyJurnal

Introduction: Responder’s action during mass environmental chemical incident involves collaboration of multiple agency. They clean the exposure site, control public safety and safe lives. The health of the responder is also as valuable as the public and always been neglected. Hence, this study is to highlights the method used and challenges during the incidents. Methods: A modified Occupational Health Surveillance Programme designed by Baker and Matte (Thirteen Steps in designing and implementing an Occupational Health Surveillance Programme) was imple-mented. These method full fill the criteria of impossible further reduce exposure to known hazards and uncertain health effect of the offending chemicals. Two core workplace namely the source of chemical contamination locale and victims’ evacuation centre were identified. The exposed responder is identified and categorised according to their expected exposure. Offending chemicals identified were known hazardous to health. An electronic survey form was developed and the surveillance were conducted during the event and post-exposures of one, third and sixth months. Laboratory tests were performed as a grab sample randomly and strategically to represent responder exposure. Results: During the event, 1338 responders were surveyed and twenty percent had symptoms of cough, headache, sore throat, nausea and skin irritation. After one-month post-exposure, three percent of responder noted to have continue symptoms. Laboratory tests were performed randomly due to the sheer numbers of responders in action. Only sixty-one samples were collected and sixteen percent had positive metabolites for urine cyanide. Re-sponders with abnormal laboratory result (FBC/LFT/RP/Urine) were interviewed and a repeat sample were performed. Conclusion: The health surveillance of the responder in mass environmental chemical incident is a great challenge when the exposure level is unsure and involve more than one chemicals. Likewise, reliability and validity adopting statistical test for health surveillance instruments is unattainable due to urgency. However, a proper method of occu-pational surveillance need to be devised and implemented to ensure the protection of worker’s health is guaranteed.

Matched MeSH terms: Nausea
Fulltext The prevalence of postoperative symptoms within 24 hours after ambulatory surgery in a University Hospital

Adlin Dasima, A.K., Karis, M.

Journal of Surgical Academia, 2013;3(2):32-38.
MyJurnal

Ambulatory surgery has now becoming increasingly popular and it is generally well accepted. Major complications following ambulatory surgery are very rare but certain postoperative symptoms can be very unpleasant and distressing to the patients. Follow-up phone calls regarding their well being at home following the surgery may give us the clue and allow us to identify certain problems that can be sorted out immediately or as a reference for a better service in future. The present study was carried out to determine the prevalence of common postoperative symptoms and their subsequent effects within 24 hours after ambulatory surgery by follow-up phone calls. We prospectively studied 199 ASA I and II patients, but only 187 patients were analyzed. Patients had undergone general surgery, orthopaedic, urology, gynaecology or ear, nose and throat (ENT) surgery. Pain was scored based on Numerical Rating Scale (NRS). Majority of patients (70.8%) had only mild pain prior to discharge home. At 24 hours postoperatively, pain was the commonest symptom reported (92.5%) followed by sleepiness (72.2%), dizziness (49.7%), sore throat (17.1%), nausea and vomiting (7.5%) and headache (7%). Sleep was mildly affected in nearly 50% of the patients. Fifty seven percent of patients did not need assistance in performing daily activities during the 24 hours, post surgery. Majority of patients were satisfied (81.3%) with ambulatory surgery. In conclusion, pain was the commonest postoperative symptom encountered following the surgery. Sleep was mildly affected by the postoperative symptoms. Most of the patients did not need assistance in performing their daily activities following surgery. All patients were able to return to at least more than 50% of their normal daily activities at 24 hours after the surgery. Overall satisfaction towards ambulatory surgery was good.

Matched MeSH terms: Nausea
Fulltext Ultrasound guided transversus abdominis plane block versus intrathecal morphine for analgesia post caesarean section: which is better?

Aizatul Isla, A.L., Wan Rahiza, W.M., Azrin, M.A., Thohiroh, A.R., Nurlia, Y., Nadia, M.N.

Journal of Surgical Academia, 2013;3(2):39-45.
MyJurnal

The tranversus abdominis plane (TAP) block for postoperative analgesia after caesarean section may confer potential benefits comparable to that of intrathecal opioids. We compared postoperative analgesia, and the incidence of nausea, vomiting, pruritus and sedation between the TAP block and intrathecal morphine (ITM) in patients undergoing Caesarean section. This was a prospective, randomised clinical study. Fifty American Society of Anaesthesiologists physical status I or II patients, planned for elective caesarean section under spinal anaesthesia, were randomly allocated to the TAP group (patients receiving spinal anaesthesia with bilateral TAP block without ITM) or ITM group (patients receiving spinal anaesthesia with ITM without a TAP block). Assessment for pain, postoperative nausea and vomiting, pruritus and sedation was done upon arrival and discharge from recovery, and at 6, 12 and 24 hours, postoperatively in the post natal ward. Results were analysed using analysis of variance (ANOVA). There was no pain at rest in either groups. Both groups experienced pain on movement at the 12th (p = 0.6) and 24th hour (p = 0.4). None of the patients in the TAP group experienced nausea, vomiting, pruritus or sedation. However, these incidences were found to be significantly higher in the ITM group. Ultrasound guided TAP block provided comparable postoperative analgesia to ITM without the side effects of the latter.

Matched MeSH terms: Postoperative Nausea and Vomiting
Fulltext Spinal anaesthesia with bupivacaine and intrathecal morphine versus combined spinal-epidural anaesthesia using Bupivacaine and Epidural infusion of bupivacaine plus fentanyl for postoperative analgesia after hip and knee arthroplasty

Mohd Azizan, G., Karis, M., Noordin, Y.

Journal of Surgical Academia, 2013;3(2):46-53.
MyJurnal

This randomised single-blinded study was conducted to evaluate if there was any difference between spinal anaesthesia with hyperbaric bupivacaine 0.5% and intrathecal morphine 0.2mg and combined-spinal epidural using hyperbaric bupivacaine 0.5% with epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml for 24 hours, postoperative analgesia following hip and knee arthroplasty, in terms of pain score and side effects (nausea, vomiting, pruritus and respiratory depression). Eighty patients ASA I or ASA II, aged between 18 to 75 years who underwent knee and hip arthroplasty of approximately 3-4 hours, duration were recruited. They were randomly allocated to one of two groups by using computer generated randomised numbers. The pain score during the postoperative period was evaluated using Visual Analogue Score (VAS pain score) and the side effects were documented and treated accordingly. Results showed that patients in Group 1 and Group 2 were comparable in terms of age, gender, height, weight and race. There was no statistical difference in VAS pain score between the two groups at all times intervals. However, patients in Group 1 had a higher incidence of nausea and pruritus than patients in Group 2. None of the patients in either group, experienced respiratory depression. Thus, it was concluded that both intrathecal morphine 0.2mg and epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml were comparable in providing postoperative analgesia up to 24 hours following hip and knee arthroplasty. Nevertheless, the use of spinal morphine led to a higher incidence of side effects namely nausea and pruritus.

Matched MeSH terms: Nausea
Fulltext Psychological and physical impact of the haze amongst a Malaysian community

Teoh, Hsien-Jin, Tan, Kai Ling

Jurnal Sains Kesihatan Malaysia, 2008;6(2):23-34.
MyJurnal

A total of 306 Malaysian university students and staff were surveyed to ascertain the physical and emotional effects of the polluted haze on them. All subjects completed self-reported questionnaires. Analysis of the results indicated that the majority of subjects reduced their outdoor activities and sports, and also reported an increase in emotional and physical health problems. The results indicated that there was a general increase in emotional problems such as feeling depressed, lacking in energy, not feeling like doing anything, feeling anxious and afraid, difficulty sleeping, feeling agitated and irritable, and having no appetite. There was also an increase in physical symptoms such as itchy or red eyes, itchy or running nose, dry throat/cough, headaches, nausea, and fever. This study indicated that emotional and behavioural problems are just as common during the haze, when compared with physical health problems. The study also suggests that there are a broad range of problems which health care and human resource departments need to be aware of and take precautions to minimize during a haze.

Matched MeSH terms: Nausea
Fulltext A randomized controlled study comparing subcutaneous pethidine with oral diclofenac for pain relief pain relief after caesarean section

Marzida, M.

JUMMEC, 2009;12(2):63-69.
MyJurnal

It is important to provide effective postoperative analgesia following a Caesarean section because mothers wish to be pain-free, mobile and alert while caring for their babies. The role of regular oral diclofenac as postoperative analgesia was evaluated in a randomized controlled study and it was compared to the established method of parenteral pethidine. Forty healthy women scheduled for elective Caesarean section under spinal anaesthesia with 2-2.5 mg of heavy bupivacaine 0.5% were randomized to receive either 75 mg of oral diclofenac twice daily or 1 mg/kg of subcutaneous pethidine every 8 hourly. Efficacy of pain relief (visual analogue score), patients' satisfaction and side effects such as sedation, nausea and vomiting were recorded for three days. The demographic variables were similar in both groups. Pain relief was adequate and comparable in both groups with similar mean visual analogue score during the second and third day of the study period. However, on the first postoperative day, 60% of the diclofenac group population required rescuemedication consisting of subcutaneous pethidine in order to achieve the same pain scores as those in the pethidine group who did not require any rescue medications. Women who received oral diclofenac reported lower sedation and higher overall satisfaction. The incidence of nausea and vomiting was similar in both groups. This concluded that although oral diclofenac 75mg twice daily may not be superior to the traditional method of subcutaneous pethidine for pain relief following caesarean section, it can still be used alone as an alternative, as it has other benefits of a non-opioid analgesia.

Matched MeSH terms: Nausea
Fulltext Issues in management of acute appendicitis in pregnancy

Nalliah, Sivalingam, Wijesuriya, Lionel, Venugopal, Subramani

International e-Journal of Science, Medicine & Education, 2011;5(1):2-9.
MyJurnal

Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery

Matched MeSH terms: Nausea
Fulltext Conquering pedaphobia: a case study of counselling interventions

Aina Razlin Mohammad Roose

Journal of Cognitive Sciences & Human Development, 2015;1(1):63-73.
MyJurnal

This paper presents a case study of a 22-year-old female client who came for counselling sessions for the purpose of overcoming her pedaphobia. Symptoms, such as, dizziness, nausea, arousal, sweating palm and body shaking were noticed to be visible not only by the presence of a real child, but also by pictures, stories and imaginations of infants. Systematic desensitization technique, a form of Exposure Therapy, was applied to treat the client. It involved relaxation and breathing techniques, and supported by the application of live modelling guided participation. Along with the interventions, Rational Emotive Behaviour Therapy techniques were also applied, such as, thought recording, irrational thoughts identification and disputation, Rational Emotive Imagery (REI), coping self-statement, and forceful self-statement. By the end of the therapy, the client reported to have experienced a decline in the occurrences of symptoms and demonstrated the ability to overcome her phobia.

Matched MeSH terms: Nausea
Health Related Quality of Life (HRQoL) among Breast Cancer Patients Receiving Chemotherapy in Hospital Melaka: Single Centre Experience

Chee Chean D, Kuo Zang W, Lim M, Zulkefle N

Asian Pac J Cancer Prev, 2016 12 01;17(12):5121-5126.
PMID: 28122444

Objective: To investigate the impact of chemotherapy on quality of life (QoL) among breast cancer patients and to evaluate the relationship with age, cancer stage and presence of any comorbidity. Methods: A prospective study was conducted among breast cancer patients receiving chemotherapy in Hospital Melaka from 1st January 2014 to 31st July 2014. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was given to patients to fill in prior chemotherapy (baseline) and after the third cycle of chemotherapy. Socio-demographic and clinical data were collected and analyzed using SPSS version 20. Result: Respondents were 32 female patients [mean age (SD): 49.7(9.93) years]. They reported a significant lower global health status (P < 0.01) and significant higher symptoms of nausea and vomiting (P < 0.01), loss of appetite (P = 0.028) and diarrhea (P = 0.026) after the third cycle of chemotherapy as compared to baseline. Compare to, this study showed significant better emotional functioning (P < 0.01) and social functioning (P < 0.01) than the EORTC QLQ-C30 Reference Values 2008 for breast cancer cases. Under symptom scales higher scores were noted for appetite loss (P = 0.017), nausea and vomiting (P < 0.01). Age, stage and comorbidity had no clear associations with global health status in our patients (P > 0.05). Conclusion: Chemotherapy did reduce the QoL of breast cancer patients. Management of chemotherapy-induced loss of appetite, diarrhea, nausea and vomiting should be improved for a better outcome.

Matched MeSH terms: Nausea
Single-centre study of therapeutic drug monitoring of posaconazole in lung transplant recipients: factors affecting trough plasma concentrations

Jeong W, Snell GI, Levvey BJ, Westall GP, Morrissey CO, Wolfe R, et al.

J Antimicrob Chemother, 2018 Mar 01;73(3):748-756.
PMID: 29211913 DOI: 10.1093/jac/dkx440

Objectives: This study describes therapeutic drug monitoring (TDM) of posaconazole suspension and modified release (MR) tablets in lung transplant (LTx) recipients and evaluates factors that may affect posaconazole trough plasma concentration (Cmin).
Methods: A single-centre, retrospective study evaluating posaconazole Cmin in LTx recipients receiving posaconazole suspension or MR tablets between January 2014 and December 2016.
Results: Forty-seven LTx patients received posaconazole suspension, and 78 received the MR tablet formulation; a total of 421 and 617 Cmin measurements were made, respectively. Posaconazole was concurrently administered with proton pump inhibitor in ≥ 90% of patients. The median (IQR) of initial posaconazole Cmin following 300 mg daily of posaconazole tablet was significantly higher than that of 800 mg daily of posaconazole suspension [1.65 (0.97-2.13) mg/L versus 0.81 (0.48-1.15) mg/L, P nausea/vomiting and weight loss) were reported in 3/78 (4%) patients receiving posaconazole MR tablets. Posaconazole Cmin in these three patients was determined to be 9.6, 6.2 and 2.3 mg/L.
Conclusions: The current study has provided clinically important insights into the TDM of posaconazole in LTx recipients. Routine TDM should be undertaken in LTx recipients receiving posaconazole suspension and/or MR tablets.

Matched MeSH terms: Nausea
Can granisetron injection used as primary prophylaxis improve the control of nausea and vomiting with low- emetogenic chemotherapy?

Keat CH, Phua G, Abdul Kassim MS, Poh WK, Sriraman M

Asian Pac J Cancer Prev, 2013;14(1):469-73.
PMID: 23534775

BACKGROUND: The purpose of this study is to examine the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with and without granisetron injection as the primary prophylaxis in addition to dexamethasone and metochlopramide.
MATERIALS AND METHODS: This was a single-centre, prospective cohort study. A total of 96 patients receiving LEC (52 with and 42 without granisetron) were randomly selected from the full patient list generated using the e-Hospital Information System (e-His). The rates of complete control (no CINV from days 1 to 5) and complete response (no nausea or vomiting in both acute and delayed phases) were identified through patient diaries which were adapted from the MASCC Antiemesis Tool (MAT). Selected covariates including gender, age, active alcohol consumption, morning sickness and previous chemotherapy history were controlled using the multiple logistic regression analyses.
RESULTS: Both groups showed significant difference with LEC regimens (p<0.001). No differences were found in age, gender, ethnic group and other baseline characteristics. The granisetron group indicated a higher complete response rate in acute emesis (adjusted OR: 0.1; 95%CI 0.02-0.85; p=0.034) than did the non-granisetron group. Both groups showed similar complete control and complete response rates for acute nausea, delayed nausea and delayed emesis.
CONCLUSIONS: Granisetron injection used as the primary prophylaxis in LEC demonstrated limited roles in CINV control. Optimization of the guideline-recommended antiemetic regimens may serve as a less costly alternative to protect patients from uncontrolled acute emesis.

Matched MeSH terms: Nausea/chemically induced; Nausea/prevention & control*
Negative impact of chemotherapy on breast cancer patients QOL - utility of antiemetic treatment guidelines and the role of race

Hassan BA, Yusoff ZB

Asian Pac J Cancer Prev, 2010;11(6):1523-7.
PMID: 21338191

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) is one of the most important worries of cancer patients. Although not life-threatening, it has a great negative impact on quality of life (QOL).
OBJECTIVE: The aim of this study was to determine the impact of CINV (i.e., acute and delayed) on breast cancer patients QOL and to discern opinions related with antiemetic guidelines used dependent on the three main races in Malaysia (Malay, Chinese, Indian).
METHODS: In this longitudinal prospective observational study, 158 breast cancer patients treated with chemotherapy were interviewed and valid questionnaires (MANE and ONEM) were used to report the impact of CINV on their QOL within the first 24 hours and after 3 to 5 days of chemotherapy treatment.
RESULTS: The main result was that delayed CINV has an impact on QOL greater than acute CINV. The impact of nausea was reportedly higher than that of vomiting. Also differences in race i.e., genetic polymorphisms (pharmacogenomics) influenced the utility of antiemetic treatments and patients opinions.
CONCLUSION: Based on the results of our study a new guideline for antiemetic treatment should be used to reduce the impact of CINV on QOL, taking into account variation in genetic polymorphisms among the three races in Malaysia.

Matched MeSH terms: Nausea/chemically induced; Nausea/drug therapy*
Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for managing highly emetogenic chemotherapy in Southeast Asia: a multinational study

Chanthawong S, Lim YH, Subongkot S, Chan A, Andalusia R, Ahmad Bustamam RS, et al.

Support Care Cancer, 2019 Mar;27(3):1109-1119.
PMID: 30112718 DOI: 10.1007/s00520-018-4400-1

PURPOSE: Recent studies suggested that olanzapine, together with dexamethasone and serotonin-3 receptor antagonist (5HT3RA), is effective in preventing chemotherapy-induced nausea and vomiting (CINV) following highly emetogenic chemotherapy (HEC). This regimen is particularly useful in Southeast Asia (SEA) countries where resources are limited. We aimed to evaluate the cost-effectiveness of incorporating olanzapine into standard antiemetic regimens for the prevention of CINV in patients receiving HEC among SEA countries.
METHODS: Using a decision tree model, clinical and economic outcomes associated with olanzapine-containing regimen and standard antiemetic regimen (doublet antiemetic regimen: dexamethasone+first generation 5HT3RA) in most SEA countries except in Singapore (triplet antiemetic regimen: dexamethasone+first generation 5HT3RA + aprepitant) for CINV prevention following HEC were evaluated. This analysis was performed in Thailand, Malaysia, Indonesia, and Singapore, using societal perspective method with 5-day time horizon. Input parameters were derived from literature, network meta-analysis, government documents, and hospital databases. Outcomes were incremental cost-effectiveness ratio (ICER) in USD/quality-adjusted life year (QALY) gained. A series of sensitivity analyses including probabilistic sensitivity analysis were also performed.
RESULTS: Compared to doublet antiemetic regimen, addition of olanzapine resulted in incremental QALY of 0.0022-0.0026 with cost saving of USD 2.98, USD 27.71, and USD 52.20 in Thailand, Malaysia, and Indonesia, respectively. Compared to triplet antiemetic regimen, switching aprepitant to olanzapine yields additional 0.0005 QALY with cost saving of USD 60.91 in Singapore. The probability of being cost-effective at a cost-effectiveness threshold of 1 GDP/capita varies from 14.7 to 85.2% across countries.
CONCLUSION: The use of olanzapine as part of standard antiemetic regimen is cost-effective for the prevention of CINV in patients receiving HEC in multiple SEA countries.

Matched MeSH terms: Nausea/chemically induced; Nausea/prevention & control*
Genetic polymorphisms in the three malaysian races effect granisetron clinical antiemetic actions in breast cancer patients receiving chemotherapy

Hassan BA, Yusoff ZB

Asian Pac J Cancer Prev, 2011;12(1):185-91.
PMID: 21517255

INTRODUCTION: Nausea and vomiting are recognized as two separate and distinct conditions with a wide spectrum of etiologies either directly associated with cancer itself or its treatment. According to the new ranking of chemotherapy side effects, nausea is the number one or the most disturbing side effects while vomiting is the third and sometimes the fifth. The introduction of 5-HT3-recptor antagonists in the early of 1990s has revolutionized the treatment of nausea and vomiting, these agents remaining the mainstay of antiemetic therapy today. Ethnic variation (due to genetic polymorphisms) may lead to diversity in antiemetic treatment pharmacokinetic and pharmacodynamic properties, in terms of distribution, elimination, disposition and clinical effects. The aim of the present study was to clarify genetic polymorphism effects in the three main races in Malaysia i.e., Malay, Chinese and Indian, on the clinical antiemetic effects of granisetron.

METHODS: In this longitudinal prospective observational study, 158 breast cancer patients treated with chemotherapy were monitored for nausea and vomiting in the first 24 hours after chemotherapy administration. The patients were then followed up again after 3 to 5 days of chemotherapy.

RESULTS: Genetic polymorphisms in the three races in Malaysia have significant effect on granisetron clinical antiemetic action because each is characterized by variant CYP3A4 enzymatic action.

CONCLUSION: According to the result, different type of 5-HT3 receptor antagonists, such as tropisetron and dolasetron which are predominantly metabolized by CYP2D6, should be used especially for Chinese breast cancer patients.

Study site: Hospital Pulau Pinang

Matched MeSH terms: Nausea/chemically induced; Nausea/drug therapy*; Nausea/ethnology; Nausea/genetics*
Fever and rash in a returning traveller

Kumar N, Lewis DJ

BMJ, 2012;344:e2400.
PMID: 22496299 DOI: 10.1136/bmj.e2400
Matched MeSH terms: Nausea/virology
Fulltext A comparison of antiemetic efficacy of droperidol alone and in combination with metoclopramide in day surgery anaesthesia

Loo CC, Thomas E, Tan HM, Sia TH

Med J Malaysia, 1997 Sep;52(3):264-8.
PMID: 10968096

We have studied the antiemetic efficacy of droperidol alone, and in combination with metoclopramide in first trimester termination of pregnancy in day surgery. The aim was to determine whether the addition of metoclopramide could further reduce the incidence of postoperative nausea and vomiting (PONV) but avoid excessive sedation. Group I (control, n = 40) received i.v. droperidol 0.625 mg at induction. Group II (study, n = 40) received i.v. droperidol 0.625 mg and i.v. metoclopramide 10 mg at induction. The incidence of nausea at 1 and 2 hours postoperatively was 23% and 10% in group I, and 5% and nil in group II respectively. The difference in the incidence of nausea was significant at p < 0.05 at one hour but not at two hours postoperatively. No patients vomited. There was no difference in the sedation and pain score between them. We did not observe any significant side effects attributable to either drug. All patients were discharged home within 3 hours. We conclude that in the prevention of PONV, the combination of metoclopramide and droperidol is superior to the use of droperidol alone at one hour but not at two hours postoperatively.

Matched MeSH terms: Postoperative Nausea and Vomiting/prevention & control*
Prolonged drug-induced myoclonus: is it related to palonosetron?

Chaw SH, Chan L, Lee PK, Bakar JA, Rasiah R, Foo LL

J Anesth, 2016 12;30(6):1063-1066.
PMID: 27510560 DOI: 10.1007/s00540-016-2228-8

We report a case of drug-induced myoclonus possibly related to palonosetron, a second-generation 5-hydroxytryptamine-3 receptor antagonist which was administered as a prophylaxis for postoperative nausea and vomiting in a 28-year-old female. The recurrent episodes of myoclonus jerk involving the head, neck and shoulder persisted for a period of 4 days. The patient also exhibited an episode of severe bradycardia leading to hypotension 7 h after surgery. To our knowledge, this is the first report presenting these adverse events potentially associated with the use of palonosetron.

Matched MeSH terms: Postoperative Nausea and Vomiting/prevention & control
Gastric foveolar cell hyperplasia and its role in postoperative vomiting in patients with infantile hypertrophic pyloric stenosis

Tan HL, Blythe A, Kirby CP, Gent R

Eur J Pediatr Surg, 2009 Apr;19(2):76-8.
PMID: 19242904 DOI: 10.1055/s-2008-1039199

Foveolar cell hyperplasia (FCH) has been reported as a rare cause of persistent gastric outlet obstruction in patients with infantile hypertrophic pyloric stenosis (IHPS), which, if present, requires excision of the gastric foveolar folds to resolve the persistent obstruction. This is a review of patients with IHPS diagnosed on abdominal ultrasound to determine the incidence of FCH in IHPS and to evaluate whether it has a causal role in postoperative vomiting following pyloromyotomy for IHPS.

Matched MeSH terms: Postoperative Nausea and Vomiting/etiology*
A brief review of current scientific evidence involving aromatherapy use for nausea and vomiting

Lua PL, Zakaria NS

J Altern Complement Med, 2012 Jun;18(6):534-40.
PMID: 22784340 DOI: 10.1089/acm.2010.0862

OBJECTIVES: The objective of this study was to compile existing scientific evidence regarding the effects of essential oils (EOs) administered via inhalation for the alleviation of nausea and vomiting.
METHODS: CINAHL, PubMed, and EBSCO Host and Science Direct databases were searched for articles related to the use of EOs and/or aromatherapy for nausea and vomiting. Only articles using English as a language of publication were included. Eligible articles included all forms of evidence (nonexperimental, experimental, case report). Interventions were limited to the use of EOs by inhalation of their vapors to treat symptoms of nausea and vomiting in various conditions regardless of age group. Studies where the intervention did not utilize EOs or were concerned with only alcohol inhalation and trials that combined the use of aromatherapy with other treatments (massage, relaxations, or acupressure) were excluded.
RESULTS: Five (5) articles met the inclusion criteria encompassing trials with 328 respondents. Their results suggest that the inhaled vapor of peppermint or ginger essential oils not only reduced the incidence and severity of nausea and vomiting but also decreased antiemetic requirements and consequently improved patient satisfaction. However, a definitive conclusion could not be drawn due to methodological flaws in the existing research articles and an acute lack of additional research in this area.
CONCLUSIONS: The existing evidence is encouraging but yet not compelling. Hence, further well-designed large trials are needed before confirmation of EOs effectiveness in treating nausea and vomiting can be strongly substantiated.

Matched MeSH terms: Nausea/therapy*

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