Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies.

Previous evidence suggested that 10 mg systemic metoclopramide is not effective to prevent postoperative nausea and/or vomiting (PONV) in patients receiving general anaesthesia. However, the evidence included data with questioned validity by the author Yoshitaka Fujii. The objective of the current study was to examine the effect of a systemic dose of 10 mg metoclopramide to prevent PONV. This quantitative systematic review was performed according to the PRISMA guidelines. A wide search was performed to identify randomized clinical trials that evaluated systemic 10 mg metoclopramide as a prophylactic agent to reduce PONV. Meta-analysis was performed using a random-effect model. Thirty trials evaluating the effect of 10 mg systemic metoclopramide in 3328 subjects on PONV outcomes were included. Metoclopramide reduced the incidence of 24 h PONV compared with control, odds ratio (OR) [95% confidence interval (CI)] of 0.58 (0.43-0.78), number needed to treat (NNT)=7.8. When evaluated as separate outcomes, metoclopramide also decreased the incidence of nausea over 24 h, OR (95% CI) of 0.51 (0.38-0.68), NNT=7.1, and vomiting over 24 h, OR (95% CI) of 0.51 (0.40-0.66), NNT=8.3. A post hoc analysis examining three studies with questioned validity performed by the author Yoshitaka Fujii that would meet criteria for inclusion in the current study did not demonstrate a significant benefit of metoclopramide compared with control on the incidence of 24 h PONV. Our findings suggest that metoclopramide 10 mg i.v. is effective to prevent PONV in patients having surgical procedures under general anaesthesia. Metoclopramide seems to be a reasonable agent to prevent PONV.

[Clinical and laboratory diagnosis of heart disease in systemic lupus erythematosus]. / Avaliação clínica e laboratorial da cardiopatia no lúpus eritematoso sistêmico.

PURPOSE: To examine heart disease in the systemic lupus erythematosus (SLE) and the association of cardiac abnormalities with anticardiolipin antibodies (ACL). METHODS: Sixteen patients with active SLE disease (group I) were compared with 14 patients without disease activity (group II). A control group of 10 healthy subjects were also evaluated. Patients were subjected to cardiovascular history and physical examination as well as electrocardiogram, thoracic x-ray, two-dimensional and Doppler echocardiogram, and ACL serum determination (ELISA). RESULTS: Myocardial disease characterized by tachycardia, heart failure or echocardiographic abnormalities was shown by 75% of patients in the group I. It was associated with ACL positive in 27.2% of these patients. Pericardial and valvular involvement were observed in 25% of patients in group I. Group II showed myocardial involvement in 21.4% of patients without positive ACL. CONCLUSION: Myocardial disease was the most frequent heart involvement in active SLE, and we did not found any association between SLE heart disease and positive anticardiolipin antibodies.