Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 4 uppsatser.

ABSTRACT Purpose: Dexamethasone provides potent analgesic and antiemetic effects. Sevoflurane are associated with an increased incidence of postoperative nausea and vomiting (PONV) and delayed patient discharge compared to propofol. This study was designed to evaluate whether the prophylatic use of dexamethasone with sevoflurane could minimize the incidence of PONV and facilitate early recovery after outpatient anorectal surgery. Methods: Forty outpatients undergoing anorectal surgery were randomly assigned to receive either dexamethasone (5 mg IV; n=20) or an equal volume of saline (n=20) before the induction of anesthesia. Anesthesia was induced with sevoflurane 8% and N2O 67% in oxygen (at 6 L/min) followed by placement of laryngeal mask. Anesthesia was maintained with sevoflurane 2-4% end-tidal in combination with N2O 50% in oxygen 3 L/min. All patients were allowed to breathe spontaneously during the operation. The postoperative nausea and vomiting (PONV), VAS pain score and patient satisfaction were recorded. Results: The incidence of PONV and VAS pain score were significant lower in dexamethasone-treated patients compared with saline-treated ones. The time required for discharge was significantly shorter in dexamethasone-treated patients. Above all, the dexamethasone-treated patients expressed higher satisfaction index. There was no significant difference in recovery time for eye opening, response to commands, orientation, and ambulatory. Conclusions: The prophylactic administration of dexamethasone reduces the incidence of PONV andVAS pain score, promotes recovery to home readiness, and improves the satisfaction after the anesthesia with spontaneously breathing of sevoflurane through laryngeal mask in outpatients undergoing anorectal surgery.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1454014. ProQuest document ID: 1679682531. Includes bibliographical references (p. 34-36)

Yes / Nausea and vomiting are common symptoms in palliative care. Haloperidol is often used as an antiemetic in this context, although direct evidence supporting this practice is limited. To evaluate the efficacy and clinical use of haloperidol as an antiemetic in nonpalliative care contexts to inform practice, the authors conducted a rapid review of (i) published evidence to supplement existing systematic reviews, and (ii) practical aspects affecting the use of haloperidol including formulations and doses that are commonly available internationally. In nausea and vomiting related to cancer treatment, haloperidol was superior to control in two small studies. In postoperative nausea and vomiting (PONV), two randomized controlledtrials found treatment with haloperidol comparable to ondansetron. In palliative care, an observational study found a complete response rate of 24% with haloperidol (one in four patients) which would be consistent with a number needed to treat (NNT) of 3 to 5 derived from PONV. There remains insufficient direct evidence to definitively support the use of haloperidol for the management of nausea and vomiting in palliative care. However, generalizing evidence from other clinical contexts may have some validity.

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV.

Uma das manifestações mais comuns em sala de recuperação anestésica é a náusea, geralmente associada à anestesia. Além do aspecto subjetivo do desconforto, os pacientes que não apresentam melhora desse sintoma podem ter alta retardada, tanto da sala de recuperação anestésica quanto hospitalar. Como conseqüências, temos a demora do retorno às funções normais, a elevação dos custos hospitalares e um menor grau de satisfação do paciente. O objetivo do presente estudo foi realizar uma análise crítica das evidências disponíveis na literatura sobre os fatores relacionados e características definidoras do diagnóstico de enfermagem náusea, no período pós-operatório imediato, por meio de uma revisão integrativa. No desenvolvimento deste estudo, utilizaram-se como fonte de levantamento de dados quatro base de dados: Lilacs, Pubmed, Cinahl e Cochrane - Revisões Sistemáticas, e a amostra constituiu-se de 31 estudos. A análise das publicações selecionadas demonstrou que as náuseas e vômitos no período pós-operatório são considerados eventos relacionados e, na maioria das vezes, avaliados como um evento único. Os fatores relacionados identificados, de acordo com a freqüência de aparecimento e nível de evidência, foram: sexo feminino, não fumante, história prévia de náuseas e vômitos no pós-operatório, história de náusea associada ao movimento, idade, tipo de cirurgia, uso de opióides no trans e pós-operatório, uso de anestésicos voláteis e administração de óxido nitroso. Em relação às características definidoras evidenciamos nos estudos analisados: palidez, taquicardia, aumento na salivação, transpiração, sensação de calor e frio, rubor, consciência do impulso do vômito, tonturas, bradicardia, dilatação pupilar, variações na pressão arterial, respiração profunda, rápida e irregular. A importância de aperfeiçoar e legitimar os elementos que fazem parte da Taxonomia II da NANDA (2006) está em possibilitar aos profissionais enfermeiros que atuam em centro cirúrgico e recuperação pós-anestésica o planejamento da assistência de enfermagem ao paciente nos três períodos da experiência cirúrgica, visando à minimização das complicações no pósoperatório e promover uma reabilitação mais rápida e tranqüila. / Nausea is one of the most common adverse events in the pots-anesthesia recovery room. It is usually associated to anesthesia. Besides the subjective aspect it can be very distressing for patients. The patients who are suffering from nausea and do show any improvement at all may have a late discharge from both the post-anesthesia recovery room and the hospital. The delayed return to normal functions, the high hospital costs, and the lower degree of the patient\'s satisfaction are some of the consequences. The aim of the present study was to perform a critical analysis of the available evidences in the literature about the related factors and the defining characteristics of nursing diagnosis nausea over the immediate postoperative period by means of an integrative review. During the development of this study systematic reviews and four databases for data collection were used: Lilacs, Pubmed, Cinahl, and Cochrane. From the screened reports, 31 of those were potentially relevant for the purpose of this study. The analysis of the retrieved studies showed that vomiting and nausea in the postoperative period are considered to be closely related and most of the time no distinction can be made between nausea and vomiting. The identified factors related according to the rate of appearance and evidence level were the following: female gender, non-smoking, prior history of vomiting and nausea in the postoperative period, history of nausea associated to motion, age, type of surgery, opioid use in a trans- and a postoperative period, use of volatile anesthetics, and nitrous oxide administration. In relation to the defining characteristics we highlighted the following: pallor, tachycardia, an increased secretion of saliva (sialorrhea, salivation), and perspiration, sensation of cold and heat, blush, awareness of the vomiting impulse, dizziness, bradycardia, pupillary dilation, arterial blood pressure changes, deep, fast, and irregular breathing. The importance to improve and to validate the NANDA\'s Taxonomy II (2006) elements is to enable the registered nurses, who work at surgery centers and anesthesia recovery rooms, to plan the nursing care for the patient in the 3-period of surgical experience aiming at to minimizing the complications in the postoperative period and to stimulate a fast and an undisturbed rehabilitation.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: Nausea and vomiting during pregnancy (NVP) is a common medical condition. Due to possible harmful side-effects that conventional medicine may pose to the fetus, many mothers choose not to use it, and are left helpless against NVP. There is a need for alternative treatment to relieve NVP symptoms. Objectives: This systematic review (SR) investigated current evidence regarding ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy, by identifying adverse events or side-effects. Search strategy: Electronic search of bibliographic databases (1966-February 2011). Selection criteria: Randomized controlled trials (RCTs) of the efficacy of ginger by any route, as treatment for NVP in pregnant women regardless of their age or stage of pregnancy. Data collection and analysis: The principal investigator and independent reviewer individually identified relevant studies, extracted data and assessed trial quality. Data analysis was performed using the RevMan5 software. Differences at the level of p<0.05 were considered to be statistically significant. Results: Eleven RCTs involving 1176 pregnant women were included. The quality of evidence was low, hence the high risk of bias and imprecision of results. Ginger significantly improved the symptoms of nausea when compared to placebo, when comparing the results of this SR to past SRs, and taking into account a meta-analysis performed on two relatively large included studies (mean difference (MD) 1.20, 95% confidence interval (CI) 0.56-1.84, p=0.0002, I2=0%). However, another meta-analysis on two smaller studies indicated no significant improvement in nausea. Ginger did not significantly improve nausea when compared to vitamin B6 (MD 0.34, 95% CI -1.52-2.20, p=0.7, I2=91%). Similarly, ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p=0.06, I2=71%). Subgroup analyses performed seemed to favor the lower daily dosage of <1500mg ginger to possibly be more effective for the relief of nausea. Ginger did not pose a significant risk for spontaneous abortion when compared to placebo (RR 3.14, 95% CI 0.65-15.11, p=0.15; I2=0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p=0.19, I2=40%). Similarly, ginger did not pose a significant risk for the side effects of heartburn or drowsiness when compared to placebo or vitamin B6. When compared to dimenhydrinate, ginger posed a smaller risk for drowsiness (RR 0.08, 95% CI 0.03-0.18) and no increased risk for heartburn. Conclusions: This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and quality of evidence). Ginger did not have a significant impact on vomiting episodes, nor pose a risk for side effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from the symptoms of NVP. Large RCTs are necessary to confirm the possible benefit of ginger as treatment for NVP. / AFRIKAANSE OPSOMMING: Agtergrond: Naarheid en vomering tydens swangerskap (NVS) is ‘n algemene mediese toestand. As gevolg van moontlike skadelike newe-effekte wat konvensionele medikasie kan veroorsaak vir die fetus, vermy baie moeders dit en word hulpeloos gelaat teen NVS. Dus is daar behoefte aan alternatiewe behandeling vir NVS. Doelwitte: Hierdie sistematiese literatuuroorsig (SO) het huidige literatuur ondersoek wat verband hou met gemmer vir behandeling van NVS. Die primêre doelwit was om effektiwiteit van gemmer as behandeling vir NVS te assesseer. Die sekondêre doelwit was om veiligheid van gemmer tydens swangerskap te assesseer, deur ongunstige gebeure en newe-effekte te identifiseer. Soektogstrategie: Elektroniese soektog van bibliografiese databasisse (1966-Februarie 2011). Seleksiekriteria: Verewekansigde gekontrolleerde proewe (RCTs) van gemmer deur enige roete as behandeling van NVS, in swanger vroue ongeag ouderdom of stadium van swangerskap. Dataversameling en –analise: Die hoof navorser en ‘n onafhanklike hersiener het individueel relevante studies geidentifiseer, data ekstraksie onderneem en studie-kwaliteit geassesseer. Data-analise is uitgevoer deur die RevMan5 sagteware te gebruik. Verskille by die vlak van p<0.05 was beskou as statisties betekenisvol. Hoof resultate: Elf RCTs waarby 1176 swanger vroue betrokke was, is ingesluit. Die studie-kwaliteit was swak, dus die hoë risiko vir sydigheid en onakkuraatheid van resultate. Gemmer het beduidend die simptome van naarheid verbeter in vergelyking met plasebo, wanneer die resultate van hierdie SO met vorige SO’s vergelyk word, en die meta-analise in ag geneem word wat op twee relatiewe groot ingeslote studies uitgevoer is (gemiddelde verskil (MD) 1.20, 95% vertrouens interval (VI) 0.56-1.84, p=0.0002,I2=0%). Kontrasterend, het ‘n ander meta-analise van twee kleiner studies geen beduidende verbetering in naarheid aangedui nie. Gemmer het nie beduidend naarheid verbeter wanneer dit met vitamien B6 vergelyk word nie (MD 0.34, 95% VI -1.52-2.20, p=0.7, I2=91%). Soortgelyk, het gemmer nie die aantal vomerings-episodes verminder, in verglyking met plasebo nie, maar daar was wel ‘n neiging na verbetering (MD 0.72, 95% VI -0.03-1.46, p=0.06, I2=71%). Die subgroup-analise blyk ten gunste te wees van die laer daaglikse dosis van <1500mg gemmer om meer effektief te wees vir die behandeling van naarheid. Gemmer het nie ‘n beduidende risiko ingehou vir spontane aborsie, wanneer dit vergelyk word met plasebo (relatiewe risiko (RR) 3.14, 95% VI 0.65-15.11,p=0.15;I2=0%), of vitamien B6 nie (RR 0.49, 95% VI 0.17-1.42,p=0.19;I2=40%). Soortgelyk, het gemmer nie ‘n beduidende risiko ingehou vir newe-effekte van sooibrand of duiseligheid, wanneer dit vergelyk word met plasebo of vitamien B6 nie. Wanneer dit vergelyk word met dimenhidrinaat, het gemmer ‘n kleiner risiko ingehou vir duiseligheid (RR 0.08, 95% VI 0.03-0.18) en geen verhoogde risiko vir sooibrand nie. Gevolgtrekkings: Hierdie SO dui ‘n potensiële voordeel van gemmer aan in vermindering van naarheid tydens swangerskap (inagnemend van die klein hoeveelheid studies, wisselende uitkomste-rapportering en studie-kwaliteit). Gemmer het nie ‘n beduidnede impak gehad op vomerings-episodes nie, en ook nie ‘n risiko ingehou vir newe-efekte of ongunstige gebeure tydens swangerskap nie. Volgens bewyse uit hierdie SO, kan gemmer beskou word as ‘n skadelose en moontlike effektiewe alternatiewe opsie vir vroue wat lei aan NVP. Grootskaalse RCTs is nodig om die moontlike voordeel van gemmer as behandeling vir NVS te bevestig.