Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.198
Filtrar
1.
BMJ Open ; 12(10): e059887, 2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36202584

RESUMO

INTRODUCTION: Hiccup is a common disease that not only occurred on adults but also on infants, which can severely do harm to patients' physical and psychological health. Metoclopramide has been reported to have effects on intractable hiccup. However, there is a limited evidence that describes the efficacy and safety of metoclopramide in the treatment of intractable hiccup. The aim of this article is to obtain evidence on the effectiveness and safety of metoclopramide in treating patients with intractable hiccup. METHODS AND ANALYSIS: We will search the following databases, including PubMed, Cochrane Library, Embase, Web of Science, CBM, Wan-fang, VIP database, CNKI and MEDLINE from their inception to 11 November 2021. All the randomised controlled trials associated with metoclopramide in treating intractable hiccup will be included. Articles screened, selected and extracted will be performed by two researchers independently. The risk of bias will be assessed by using the Cochrane Collaboration. We will carry out the meta-analysis by using RevMan V.5.4 software. PROSPERO REGISTRATION NUMBER: CRD42021293000.


Assuntos
Soluço , Adulto , Gerenciamento de Dados , Soluço/tratamento farmacológico , Humanos , Metanálise como Assunto , Metoclopramida/efeitos adversos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Clin Lymphoma Myeloma Leuk ; 22 Suppl 2: S433, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36164196

RESUMO

G6PD deficiency is an inherited condition characterized by a lack of glucose-6-phosphate dehydrogenase, leading to hemolytic anemia after any oxidative stress. Many therapeutic agents have been implicated in hemolysis in G6PD-deficient patients, but little is known about the prevalence of G6PD deficiency in cancer patients. Data regarding the use and safety of chemotherapy in this population is extremely rare. We report the case of a 20-year-old male patient known to have G6PD deficiency who was diagnosed with a stage I non-seminomatous germ cell tumor (NSGCT). He underwent a left orchiectomy, revealing the presence of NSGCT with embryonal carcinoma predominance and lymphovascular invasion. Postoperative tumor markers (lactate dehydrogenase [LDH], αFP, ßHCG) and a chest-abdomen-pelvis CT scan were within normal limits. Thus, he was a candidate to receive one cycle of BEP protocol (bleomycin, etoposide, and cisplatin). An extensive review of the literature regarding the premedications (aprepitant, palonosetron, metoclopramide, omeprazole, desloratadine, dexamethasone) and chemotherapeutic agents did not reveal any associated or reported hemolysis in patients with G6PD deficiency. A baseline hemolytic panel was tested, and hemoglobin, LDH, haptoglobin, bilirubin, and the reticulocyte count fell within normal limits. The patient received one cycle of BEP with serial hemolytic panel testing during the treatment administration, which did not reveal any induced hemolysis. He is currently in complete remission of his disease. Excluding case reports of rasburicase and one case of anthracycline-induced hemolysis in G6PD-deficient patients, descriptions of chemotherapy uses and outcomes in this population are extremely limited in the literature. Clinicians must consider the potential benefit of treatment to decide on cytotoxic therapies in G6PD-deficient patients. As medical oncologists, we believe that more information is required to support the safety of chemotherapy in this population.


Assuntos
Deficiência de Glucosefosfato Desidrogenase , Adulto , Antraciclinas , Aprepitanto , Bilirrubina , Biomarcadores Tumorais , Bleomicina , Cisplatino/efeitos adversos , Dexametasona , Etoposídeo , Glucosefosfato Desidrogenase/metabolismo , Deficiência de Glucosefosfato Desidrogenase/diagnóstico , Haptoglobinas , Hemoglobinas/análise , Hemólise , Humanos , L-Lactato Desidrogenase , Masculino , Metoclopramida , Omeprazol , Palonossetrom , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
BMC Neurol ; 22(1): 366, 2022 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-36138349

RESUMO

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, and ALS patients may experience disturbed gastrointestinal motility often resulting in acute colonic pseudo-obstruction (ACPO). There is currently a paucity in the literature to guide the treatment of patients with both ALS and ACPO. CASE PRESENTATION: Here we describe a 39-year-old male patient with advanced ALS who developed ACPO. His condition was refractory to both medical and procedural managements including polyethylene glycol, senna, and docusate suppository, metoclopramide, linaclotide, erythromycin, prucalopride, neostigmine, and repeated colonoscopies. He ultimately underwent successful colostomy for palliation. Here we report the peri-operative multidisciplinary approach taken with this case, the surgical procedures, the potential risks, and the outcome. CONCLUSION: The patient is delighted with the result and requested publication of this case to raise awareness of constipation in ALS patients and promote the consideration of colostomy as a treatment option for patients with ileus resistant to conservative management. Ultimately, a multidisciplinary team approach is required to properly assess the risks and benefits to achieve good clinical outcomes.


Assuntos
Esclerose Amiotrófica Lateral , Pseudo-Obstrução do Colo , Doença Aguda , Adulto , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/tratamento farmacológico , Pseudo-Obstrução do Colo/complicações , Pseudo-Obstrução do Colo/tratamento farmacológico , Pseudo-Obstrução do Colo/cirurgia , Colostomia/efeitos adversos , Ácido Dioctil Sulfossuccínico/uso terapêutico , Eritromicina/uso terapêutico , Humanos , Masculino , Metoclopramida/uso terapêutico , Neostigmina/efeitos adversos , Polietilenoglicóis/uso terapêutico
4.
J Cardiothorac Vasc Anesth ; 36(11): 4129-4140, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36028379

RESUMO

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) is carried out in various clinical settings, with an increasing importance, and sedation usually is required to perform it. Several sedative agents are available, and the authors aimed to compare the cardiovascular and respiratory safety of the strategies used for sedation in TEE through a systematic review with network meta-analysis (NMA). The MEDLINE, CENTRAL, EMBASE, and PsycInfo databases were searched in December 2020 for randomized clinical trials (RCTs) comparing sedation strategies for patients undergoing TEE. The authors assessed variations in systolic blood pressure (SBP), heart rate (HR), and peripheral oxygen saturation (SpO2), along with the incidences of hypotension, bradycardia, and desaturation. A random-effect meta-analysis was performed. Nine RCTs (N = 881 patients) with 20 active arms (5 dexmedetomidine; 4 propofol; 4 midazolam; 3 midazolam + opioid; 2 ketamine + propofol; 1 midazolam + ondansetron; 1 midazolam + metoclopramide) and 1 placebo arm were included. Dexmedetomidine was associated with decreases in SBP (mean difference [MD] = -18.78 mmHg; 95% CI [-26.27 to -11.28]) and HR (MD = -11.15 beats/min; 95% CI [-16.15 to -6.15]). Dexmedetomidine significantly reduced the HR compared with ketamine + propofol (-16.90 beats/min; 95% CI: -33.21 to -0.58]) and midazolam + opioid (-24.15 beats/min; 95% CI: -42.67 to -5.63). Midazolam was found to reduce SBP (-12.09 mmHg; 95% CI: -20.43 to -3.74) and was shown to reduce SpO2 compared with the placebo (-1.00%; 95% CI -1.74 to -0.26). Based on the NMA, the drugs with a higher likelihood of decreasing both SBP and HR were dexmedetomidine and midazolam. All of the drugs led to a small decrease (only statistically significant for midazolam) in SpO2, with the systematic use of supplemental O2 in some trials. The risks of hypotension, bradycardia, or desaturation were not significantly different among the evaluated drugs.


Assuntos
Dexmedetomidina , Hipotensão , Ketamina , Propofol , Analgésicos Opioides , Bradicardia/induzido quimicamente , Ecocardiografia Transesofagiana/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/induzido quimicamente , Hipotensão/prevenção & controle , Metoclopramida , Midazolam/efeitos adversos , Metanálise em Rede , Ondansetron
5.
Clin Neuropharmacol ; 45(5): 135-138, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35947416

RESUMO

CASE: A 52-year-old man developed a cerebral infarction from the right middle cerebral artery occlusion, and the infarction extensively damaged the right insula. Three months after the onset of the cerebral infarction, persistent hiccups appeared, occurring during sleep. The thoracic and abdominal cavities showed no lesions; hence, the hiccups were considered to be caused by central nervous system dysfunction. Administration of metoclopramide, chlorpromazine, and diazepam were ineffective, while levetiracetam had a partial effect. Combining perampanel with baclofen finally suppressed the symptoms. DISCUSSION: Lesions at the right insula impair respiratory reflex and may present with hiccups as a symptom of respiratory reflex disinhibition. Here, we review similar cases of treatment-resistant hiccups, as well as perampanel and baclofen efficacy in myoclonus cases. CONCLUSIONS: Our patient's case suggested that perampanel with baclofen may be effective for myoclonus due to respiratory reflex disinhibition and can be used to treat hiccups derived from cerebral infarctions.


Assuntos
Soluço , Mioclonia , Baclofeno/uso terapêutico , Infarto Cerebral/complicações , Infarto Cerebral/tratamento farmacológico , Clorpromazina , Diazepam , Soluço/tratamento farmacológico , Soluço/etiologia , Humanos , Infarto/complicações , Levetiracetam , Masculino , Metoclopramida , Pessoa de Meia-Idade , Nitrilas , Piridonas
6.
Sci Rep ; 12(1): 13894, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35974090

RESUMO

Monosodium glutamate induces behaviors thought to reflect headache and nausea in rats. We explored the effects of the N-methyl-D-aspartate receptor antagonist (2R)-amino-5-phosphonovaleric acid, the inotropic glutamate receptor antagonist kynurenic acid, and the CGRP receptor antagonist olcegepant, on monosodium glutamate-induced increases in nocifensive, headache-like and nausea behaviours. Effects of these antagonists on motor function were examined with a rotarod. The effect of the dopamine receptor antagonist metoclopramide and the serotonin 3 receptor antagonist ondansetron on nausea behaviour was also assessed. (2R)-amino-5-phosphonovaleric acid, and to a lesser extent, kynurenic acid and olcegepant, reduced nocifensive and headache-like behaviours evoked by monosodium glutamate. No alteration in motor function by (2R)-amino-5-phosphonovaleric acid, kynurenic acid or olcegepant was observed. No sex-related differences in the effectiveness of these agents were identified. Nausea behaviour was significantly more pronounced in male than in female rats. Olcegepant, ondansetron and metoclopramide ameliorated this nausea behaviour in male rats. Ondansetron and metoclopramide also reduced headache-like behaviour in male rats. These findings suggest that peripheral N-methyl-D-aspartate receptor activation underlies monosodium glutamate-induced headache-like behaviour but does not mediate the nausea behaviour in rats.


Assuntos
Cefaleia , Receptores de N-Metil-D-Aspartato , Glutamato de Sódio , Aminoácidos , Animais , Ácido Aspártico , Feminino , Ácido Glutâmico , Cefaleia/induzido quimicamente , Ácido Cinurênico/farmacologia , Masculino , Metoclopramida , Náusea , Ondansetron/farmacologia , Ratos , Receptores de N-Metil-D-Aspartato/metabolismo , Glutamato de Sódio/efeitos adversos
7.
J Stroke Cerebrovasc Dis ; 31(9): 106633, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35914512

RESUMO

In the present study, we report a case of persistent intractable nausea and vomiting after a medullary infarction. Area postrema syndrome due to ischemic stroke is very rare. In this case, brain magnetic resonance imaging revealed an ischemic lesion in the lateral medulla extending caudally and dorsomedially. The patient presented with sustained nausea, vomiting, and poor oral intake over one month after the index stroke, even after resolution of dizziness and disappearance of nystagmus. She did not respond to intravenous metoclopramide with ondansetron. However, their intractable nausea and vomiting eventually resolved with concomitant use of domperidone and itopride orally in addition to intravenous metoclopramide with ondansetron.


Assuntos
Área Postrema , Ondansetron , Área Postrema/diagnóstico por imagem , Área Postrema/patologia , Feminino , Humanos , Infarto/patologia , Metoclopramida/uso terapêutico , Náusea/etiologia , Síndrome , Vômito/complicações
8.
J Vet Intern Med ; 36(5): 1726-1732, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35906792

RESUMO

BACKGROUND: Nausea and emesis can be, among other signs, common manifestations of acute vestibular system dysfunction in dogs. Currently, antiemetic drugs, such as maropitant and metoclopramide, are used commonly, but do not appear to control nausea. A non-placebo-controlled preliminary study suggested good efficacy of 5-HT3-receptor antagonists, such as ondansetron, against nausea in dogs with vestibular syndrome. OBJECTIVES: To assess and confirm the effect of ondansetron on behavior suggestive of nausea in dogs with vestibular syndrome. ANIMALS: Fourteen dogs with vestibular syndrome and clinical signs of nausea presented to a neurology service. METHODS: Placebo-controlled, double-blinded, crossover study. Behavioral assessment was performed hourly for 4 hours using an established numerical rating scale. The criteria salivation, lip licking, vocalization, restlessness, lethargy, and general nausea were scored. The occurrence of emesis was recorded. After scoring at T0 (pre-dose) and T2 (2 hours post-dose) either ondansetron (0.5 mg/kg) or placebo was injected IV. Two hours post-dose, treatments were switched. Blood samples were collected to measure serum arginine vasopressin (AVP) concentration, which previously has been shown to correlate with clinical signs of nausea. RESULTS: Clinical resolution of nausea was observed 1 hour after administration of ondansetron, whereas serum AVP concentration decreased 4 hours after ondansetron administration. CONCLUSION AND CLINICAL IMPORTANCE: Administration of ondansetron IV is beneficial for dogs with nausea secondary to acute vestibular syndrome. Ondansetron substantially and rapidly decreased clinical signs of nausea behavior and stopped emesis.


Assuntos
Antieméticos , Doenças do Cão , Doenças Vestibulares , Animais , Antieméticos/uso terapêutico , Arginina Vasopressina/uso terapêutico , Estudos Cross-Over , Doenças do Cão/tratamento farmacológico , Cães , Método Duplo-Cego , Metoclopramida , Náusea/tratamento farmacológico , Náusea/veterinária , Ondansetron/uso terapêutico , Doenças Vestibulares/complicações , Doenças Vestibulares/tratamento farmacológico , Doenças Vestibulares/veterinária , Vômito/tratamento farmacológico , Vômito/veterinária
9.
Eur J Pharm Sci ; 175: 106222, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35649471

RESUMO

The drug delivery systems are an important strategy of pharmaceutical technology to modulate undesirable properties, increasing efficacy, and reducing the side effects of active pharmaceutical ingredients (API). The sustained release is a type of controlled-release system that provides a suitable drug level in the blood through a slow release rate. An interesting alternative to achieve a controlled release is the application of carrier materials such as polymers, cyclodextrins, and clays. Sodium montmorillonite (Na-MMT) is a biocompatible natural clay that allows the insertion of organic compounds in interlamellar space, owing to its high cation exchange capacity and large internal surface area. Bromopride (BPD) is an aminated compound with antiemetic properties classified as class II (low solubility, high permeability) of the Biopharmaceutical Classification System (BCS). Herein, the aim of the study was the development and investigation of a drug delivery system formed by intercalation of BPD with Na-MMT. The results indicate the successful intercalation of this API with the lamellar silicate, meanwhile, there was no evidence of BPD intercalation in organic montmorillonite. The Na-MMT/BPD molecular complex exhibits a sustained release in performed assays. Molecular dynamics simulations suggested that BPD molecules interact with the montmorillonite layer through ion-dipole interactions and also between BPD molecules, forming hydrogen bonds web into montmorillonite interlayer space. The new drug delivery system showed an alternative to achieve the BPD sustained release, which may improve its pharmacological performance in therapeutic applications.


Assuntos
Bentonita , Metoclopramida , Bentonita/química , Argila , Preparações de Ação Retardada , Metoclopramida/análogos & derivados
10.
Headache ; 62(6): 681-689, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35670115

RESUMO

OBJECTIVE: The objective of this study was to assess the efficacy and safety of a common monotherapy (intravenous [iv] metoclopramide) compared to a combination strategy (adding iv ketorolac to metoclopramide) in children presenting for acute treatment of migraine headache in the emergency department (ED). METHODS: Children aged 5-17 years presenting for acute treatment of migraine headache at two pediatric EDs were enrolled in a double-blind randomized controlled trial. Children were randomly assigned to receive iv metoclopramide 0.2 mg/kg) and placebo or iv metoclopramide (0.2 mg/kg) and ketorolac (0.5 mg/kg). The primary outcome was a mean change in pain from baseline to 120 min via a 100 mm Visual Analog Scale (VAS). Follow-up was conducted 24-h after discharge. RESULTS: Fifty-three children were randomized and included in the analysis (monotherapy group [metoclopramide + placebo], n = 27; and ketorolac group [metoclopramide + ketorolac], n = 26); mean age was 12.9 ± 2.7 years and baseline pain severity on VAS was 67.3 ± 2.7 mm. The mean change in pain intensity at 120 min was -44 mm (SD: 24; 95% confidence interval [CI]: 32-57) for the monotherapy group and -36 mm (SD: 24; 95% CI: 23-49) for the ketorolac group, with a mean difference between groups of 8 mm (95% CI: -9-25; p = 0.360). Seventeen percent of the children (9/53; 95% CI: 7-27%) were pain-free at discharge. There was no difference in headache recurrence or adverse events between groups. CONCLUSIONS: The approach of combining iv metoclopramide with ketorolac failed to improve pain scores in children presenting for acute treatment of migraine headache in the ED compared to metoclopramide monotherapy. Most patients were discharged with residual pain. Further comparative studies are needed to test alternative ED treatments for migraine in children or adolescents.


Assuntos
Metoclopramida , Transtornos de Enxaqueca , Adolescente , Criança , Método Duplo-Cego , Serviço Hospitalar de Emergência , Cefaleia/tratamento farmacológico , Humanos , Cetorolaco/uso terapêutico , Metoclopramida/efeitos adversos , Transtornos de Enxaqueca/induzido quimicamente , Transtornos de Enxaqueca/tratamento farmacológico , Resultado do Tratamento
11.
Neuropsychopharmacol Rep ; 42(3): 380-383, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35716124

RESUMO

BACKGROUND: Antipsychotics with dopamine (D2) receptor antagonism can be effective for emesis in cancer patients. Extrapyramidal symptoms (EPS) induced by typical antipsychotics can be exacerbated by other D2 receptor antagonists. We describe a case of persistent EPS induced by long-term, intermittent administration of low-dose olanzapine along with metoclopramide for emesis. CASE PRESENTATION: A 59-year-old pancreatic cancer patient underwent chemotherapy for 7 months. He was referred to the psychiatry department because of restlessness and insomnia. Although he did not have obvious depressive symptoms, he was anxious about the cancer treatment. For chemotherapy-induced nausea, he had been prescribed 5 mg of olanzapine intermittently for 7 months. He had last used the drug 9 days before presenting it to us. Additionally, he received metoclopramide and palonosetron as antiemetics. We considered akathisia and cancer-related anxiety/agitation as possible causes of restlessness and insomnia, and prescribed clonazepam. However, his symptoms worsened, resulting in hospitalization. We reconsidered his symptoms as cancer-related anxiety/agitation and prescribed quetiapine. Although it was effective, he had tremors and was assessed by a neurologist. Considering the clinical manifestations of rigidity, postural reflex disorder, and a mask-like face, we suspected drug-induced parkinsonism and replaced quetiapine with biperiden on the next day, leading to his discharge after 2 weeks. He did not have symptom recurrence even after discontinuation of biperiden. CONCLUSIONS: Long-term, intermittent administration of low-dose antipsychotics with other antiemetics having D2 receptor antagonism can cause prolonged EPS. Especially in cancer patients, who often require polypharmacy, clinicians should consider exacerbated adverse effects due to drug interactions.


Assuntos
Antieméticos , Antineoplásicos , Antipsicóticos , Distúrbios do Início e da Manutenção do Sono , Antieméticos/efeitos adversos , Antipsicóticos/efeitos adversos , Biperideno , Clonazepam , Dopamina , Humanos , Masculino , Metoclopramida/efeitos adversos , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Palonossetrom , Agitação Psicomotora/tratamento farmacológico , Fumarato de Quetiapina , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Vômito/induzido quimicamente , Vômito/tratamento farmacológico
12.
BMC Pregnancy Childbirth ; 22(1): 464, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35655181

RESUMO

BACKGROUND: Women suffering from severe nausea and vomiting during pregnancy, hyperemesis gravidarum, have poor quality of life and increased risk of potentially fatal maternal and fetal complications. There is increasing and reassuring knowledge about safety of antiemetics in pregnancy. In 2013, the European Medical Agency (EMA) issued a warning on metoclopramide limiting treatment to maximum five days. Metoclopramide was the most used antiemetic in pregnancy at the time the warning was implemented in the Norwegian hyperemesis guidelines (2014). We aimed at describing changes in the treatment of hyperemesis over time, including changes associated with the EMA warning. METHODS: Retrospective chart review of all women hospitalized for hyperemesis gravidarum with metabolic disturbances between 01/Jan/2002 and 31/Dec/2019 at a university hospital serving nearly 10% of the pregnant population in Norway. Time-series analysis described changes over time and interrupted time series analysis quantified changes in treatment and clinical outcomes related to the EMA warning. RESULTS: In total, 1,064 women (1.2% of the birthing population) were included. The use of meclizine, prochlorperazine, and ondansetron increased during 2002-2019. This led to a yearly increase in the percentage of women using any antiemetic of 1.5% (95%CI 0.6; 2.4) pre-hospital, 0.6% (95%CI 0.2; 1.1) during hospitalization, and 2.6% (95%CI 1.3; 3.8) at discharge. Overall, only 50% of the women received antiemetics pre-hospital. Following the EMA warning, prehospital use of metoclopramide dropped by 30% (95%CI 25; 36), while use of any antiemetic pre-hospital dropped by 20% (95%CI 5.7; 34). In timely association, we observed a decrease in gestational age (-3.8 days, 98.75%CI 0.6; 7.1) at first admission, as well as indication of increased rate of termination of pregnancy with an absolute increase of 4.8% (98.75%CI 0.9; 8.7) in 2014. CONCLUSION: During 2002-2019, the overall use of antiemetics in treatment of hyperemesis increased. The EMA-warning on metoclopramide in 2013 temporarily limited pre-hospital antiemetic provision associated with hospitalization at lower gestational length and indication of an increase in termination of pregnancy.


Assuntos
Antieméticos , Hiperêmese Gravídica , Antieméticos/uso terapêutico , Feminino , Humanos , Hiperêmese Gravídica/epidemiologia , Metoclopramida/uso terapêutico , Gravidez , Qualidade de Vida , Estudos Retrospectivos
13.
Cochrane Database Syst Rev ; 5: CD013860, 2022 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-35588093

RESUMO

BACKGROUND: Physicians often prescribe opioids for pain in the acute care setting. Nausea and vomiting are well-described adverse events, occurring in over one-third of patients. Prophylactic antiemetics may be one option to reduce opioid-associated nausea and vomiting. However, these medications also have their own adverse effects, so it is important to understand their efficacy and safety prior to routine use. This is a review of randomized controlled trials comparing prophylactic antiemetics versus placebo or standard care for preventing opioid-associated nausea and vomiting. OBJECTIVES: To assess the effects of prophylactic antiemetics for nausea and vomiting in adults (aged 16 years or older) receiving intravenous opioids in the acute care setting. SEARCH METHODS: We searched CENTRAL (the Cochrane Library), MEDLINE (OVID), Embase (OVID) from inception to January 2022, and Google Scholar (17 January 2022). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and screened reference lists. SELECTION CRITERIA: We included randomized controlled trials of prophylactic antiemetics versus placebo or standard care in adults prior to receiving an intravenous opioid. DATA COLLECTION AND ANALYSIS: Two review authors (MG, JNC) independently determined the eligibility of each study according to the inclusion criteria. Two review authors (MG, GDP) then independently extracted data, assessed risk of bias, and determined the certainty of evidence using GRADE. Our primary outcomes were the occurrence of nausea, vomiting, and adverse events. Secondary outcomes included nausea severity, number of vomiting episodes, and number of participants requiring antiemetic rescue therapy. We presented outcomes as risk ratios (RR) for dichotomous data (e.g. presence of vomiting, presence of nausea, number of participants requiring rescue medication, adverse events) and mean difference (MD) or standardized mean difference for continuous data (e.g. number of vomiting episodes, nausea severity) with 95% confidence intervals (CI). MAIN RESULTS: We included three studies involving 527 participants (187 women and 340 men) with a mean age of 42 years.  All studies used intravenous metoclopramide (10 mg) as the intervention and a placebo for the comparator. No studies assessed any other antiemetic or compared the intervention to standard care. Compared to placebo, metoclopramide did not reduce vomiting (RR 1.18, 95% CI 0.26 to 5.32; low-certainty evidence) or nausea (RR 0.55; 95% CI 0.15 to 2.03; low-certainty evidence) and there was no difference in adverse events (RR 2.34, 95% CI 0.47 to 11.61; low-certainty evidence).  No data were available regarding the number of vomiting episodes. Metoclopramide did reduce the severity of nausea compared with placebo (MD -0.49, 95% CI -0.75 to -0.23; low-certainty evidence) but did not reduce the need for rescue medication (RR 1.86, 95% CI 0.17 to 20.16; low-certainty evidence).  Two studies were at unclear risk of bias for random sequence generation, one for blinding of outcome assessors, one for incomplete outcome data, and two for selective reporting. The studies were at low risk of bias for all remaining components. AUTHORS' CONCLUSIONS: There was no evidence that prophylactic metoclopramide affected the risk of vomiting, nausea, or the need for rescue medication when provided prior to intravenous opioids in the acute care setting. There was a clinically insignificant difference in nausea severity when comparing prophylactic metoclopramide with placebo. Overall, the evidence was of low certainty. Future research could better delineate the effects of prophylactic antiemetics on specific populations, and new studies are needed to evaluate the use of other prophylactic antiemetic agents, for which there were no data.


Assuntos
Antieméticos , Adulto , Analgésicos Opioides/efeitos adversos , Antieméticos/efeitos adversos , Feminino , Humanos , Masculino , Metoclopramida/efeitos adversos , Náusea/induzido quimicamente , Náusea/tratamento farmacológico , Náusea/prevenção & controle , Vômito/induzido quimicamente , Vômito/tratamento farmacológico , Vômito/prevenção & controle
14.
Clin Transl Gastroenterol ; 13(6): e00498, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-35584543

RESUMO

INTRODUCTION: Optimizing the accuracy of colon capsule endoscopy (CCE) requires high completion rates. To prevent incomplete CCE, we aimed to identify predictors associated with slow CCE transit times. METHODS: In this population-based study, participants received CCE with a split-dose polyethylene glycol bowel preparation and booster regimen (0.5 L oral sulfate solution and 10 mg metoclopramide if capsule remained in stomach for > 1 hour). The following predictors were assessed: age, sex, body mass index (BMI), smoking, coffee and fiber intake, diet quality, physical activity, dyspeptic complaints, stool pattern, history of abdominal surgery, medication use, and CCE findings. Multivariable logistic and linear regressions with backward elimination were performed. RESULTS: We analyzed 451 CCE procedures with a completion rate of 51.9%. The completion rate was higher among older participants (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.03) and participants with a changed stool pattern (OR 2.27, 95% CI 1.20-4.30, P = 0.01). Participants with a history of abdominal surgery had a lower completion rate (OR 0.54, 95% CI 0.36-0.80, P = 0.003). Participants with higher BMI had faster stomach, small bowel, and total transit times (ß = -0.10, P = 0.01; ß = -0.14, P = 0.001; ß = -0.12, P = 0.01). A faster small bowel transit was found in participants with a changed stool pattern (ß = -0.08, P = 0.049) and the use of metoclopramide (ß = -0.14, P = 0.001). Participants with high fiber intake had a slower colonic transit (ß = 0.11, P = 0.03). DISCUSSION: Younger age, unchanged stool pattern, history of abdominal surgery, low BMI, and high fiber intake resulted in slower CCE transit times and lower completion rates. In future practice, these factors can be considered to adjust preparation protocols.


Assuntos
Endoscopia por Cápsula , Endoscopia por Cápsula/métodos , Colo/diagnóstico por imagem , Colo/cirurgia , Colonoscopia/métodos , Trânsito Gastrointestinal , Humanos , Metoclopramida
15.
Braz J Biol ; 84: e260566, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35613215

RESUMO

Chrozophora tinctoria (L.) A.Juss. is herbaceous, monecious annual plant used traditionally to cure gastrointestinal disorders. The present study was carried out to find the bioactive compounds by Gas Chromatography-Mass Spectrometry, the acetylcholinesterase inhibitory potential acute toxicity, and emetic activity present in the ethyl acetate fraction of Chrozophora tinctoria (EAFCT) and dichloromethane fraction of Chrozophora tinctoria (DCMFCT). The compounds detected in both fractions were mostly fatty acids, with about seven compounds in EAFCT and 10 in DCMFCT. These included pharmacologically active compounds such as imipramine, used to treat depression, or hexadecanoic acid methyl ester, an antioxidant, nematicide, pesticide, hypocholesterolemic, 9,12,15-Octadecatrienoic acid, ethyl ester, (Z,Z,Z)- is used as a cancer preventive, antiarthritic, antihistaminic, hepatoprotective, insectifuge, nematicide, Pentadecanoic acid, 14-methyl-, methyl ester have antifungal, antimicrobial and antioxidant activities, 10-Octadecanoic acid, methyl ester have the property to decrease blood cholesterol, Antioxidant and antimicrobial, 1-Eicosanol is used as an antibacterial, 1-Hexadecene has antibacterial, antioxidant, and antifungal activities. Both DCMFCT and EAFCT fractions inhibited acetylcholinesterase (AChE) activity with IC50 values of 10 µg and 130 µg, respectively. Both the fractions were found to be toxic in a dose-dependent manner, inducing emesis at 0.5g onward and lethargy and mortality from 3-5 g upwards. Both the fractions combined with distilled water showed highly emetic activity. The significant increase in the number of vomits was shown by EAFCT plus distilled water which are 7.50±1.29, 7.25±3.10, and 11.75±2.22 number of vomits at 1g, 2g, and 3g/kg concentration respectively, while DCMFCT plus distilled water showed 5.25±2.22, 7.50±2.52 and 10.25±2.22 number of vomits at 1g, 2, and 3g/kg correspondingly. The antiemetic standard drug metoclopramide has a higher impact against the emesis induced by both the fractions than dimenhydrinate. Metoclopramide decreases the number of vomits caused by EAFCT to 1.00±0.00, 2.00±0.00, 4.00±1.00 at 1g, 2, and 3g/kg sequentially, while dimenhydrinate decreases the number of vomits to 1.33±0.58, 2.33±1.15, 4.33±0.58 at 1g, 2, and 3g respectively. In the same way, Metochloprimide decreases the number of emesis caused by DcmCt from 5.25±2.22, 7.50±2.52, 10.25±2.22 to 1.33±0.58, 2.33±1.1, 4.33±0.58 at 1g, 2, and 3g/kg concentrations. The present study is the first documented report that scientifically validates the folkloric use of Chrozophora tinctoria as an emetic agent.


Assuntos
Dimenidrinato , Euphorbiaceae , Acetilcolinesterase , Animais , Antibacterianos/farmacologia , Antifúngicos/farmacologia , Antioxidantes/farmacologia , Dimenidrinato/análise , Eméticos/análise , Ésteres/análise , Cromatografia Gasosa-Espectrometria de Massas , Metoclopramida/análise , Modelos Animais , Extratos Vegetais/uso terapêutico , Extratos Vegetais/toxicidade , Vômito , Água
16.
Med Gas Res ; 12(4): 137-140, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435424

RESUMO

Prevention and management of postoperative nausea and vomiting (PONV) is a fundamental part of anesthesia. Using sevoflurane and propofol in combination for maintenance of anesthesia has been found to reduce PONV compared to sevoflurane alone. However, there are limited studies comparing propofol with a combination of propofol and sevoflurane for the incidence of PONV after laparoscopic surgery. The prospective, randomized, double-blind study was planned to compare propofol and combination of propofol and sevoflurane as maintenance agents for the incidence of PONV. Seventy female patients of 18-60 years, of American Society of Anesthesiologists I or II, undergoing laparoscopic surgery were included. Propofol group (n = 35) included induction with propofol and maintenance with propofol infusion, and propofol + sevoflurane group (n = 35) included induction with propofol and maintenance with a combination of propofol infusion and sevoflurane inhalation. The objectives were to find the incidence of PONV and requirement of rescue antiemetic. In the propofol group, 11 patients (33%) experienced PONV and in the propofol + sevoflurane group, PONV was experienced by 12 patients (38.7%) [0.65]. In the propofol group, 11 patients required ondansetron and out of these 11 patients, 2 patients required metoclopramide. In the propofol + sevoflurane group, Ondansetron was required by 12 patients and 3 patients out of these 12 patients required metoclopramide. In the present study, the incidence of PONV was found to be similar in both groups. So, it can be suggested to add sevoflurane in smaller doses to infusion of propofol for maintenance of anesthesia.


Assuntos
Laparoscopia , Propofol , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Laparoscopia/efeitos adversos , Metoclopramida , Pessoa de Meia-Idade , Ondansetron , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Propofol/uso terapêutico , Estudos Prospectivos , Sevoflurano , Adulto Jovem
17.
BMC Anesthesiol ; 22(1): 130, 2022 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488196

RESUMO

BACKGROUND: To investigated the effects of sufentanil in combination with flurbiprofen axetil and dexmedetomidine for patient-controlled intravenous analgesia (PCIA) on patients after open gastrointestinal tumor surgery, and compared this combination with traditional PCIA with pure opioids or epidural analgesia (PCEA). METHODS: Patients (n = 640) who underwent open gastrointestinal tumor surgery and received patient-controlled analgesia (PCA) were included. According to the type of PCA, patients were assigned to three groups: MPCIA (PCIA with sufentanil, flurbiprofen axetil, dexmedetomidine and metoclopramide), OPCIA (PCIA with sufentanil, tramadol and metoclopramide) and PCEA group (PCEA with sufentanil and ropivacaine). The characteristics of patients, intraoperative use of analgesics, postoperative visual analogue scale (VAS), postoperative adverse reactions and postoperative recovery were collected. The primary outcome was postoperative VAS score. One-way ANOVA, Kruskal-Wallis H test, Fisher exact probability method, and binary logistic regression analysis were used for analysis. RESULTS: There were no significant differences in the characteristics of patients, operation time, tumor site and the use of postoperative rescue analgesics among the groups. In the first two days after open gastrointestinal tumor surgery, the VAS (expressed by median and interquartile range) of MPCIA (24th h, resting: 1,1; movement: 3,2. 48th h, resting: 0,1; movement: 2,1.) and PCEA (24th h, resting: 0,1; movement: 2,1. 48th h, resting: 0,1; movement: 2,2.) groups were significantly lower than those of OPCIA group (24th h, resting: 2.5,2; movement: 4,2. 48th h, resting: 1.5,1.75; movement: 3,1.) (all p <  0.01). The incidence of postoperative nausea and vomiting in MPCIA group was 13.6% on the first day after surgery, which was significantly higher than that in PCEA group. There was no significant difference in the incidence of other postoperative adverse events. Higher intraoperative sufentanil dosage (OR (95%CI) = 1.017 (1.002-1.031), p = 0.021), lower body mass index (OR (95%CI) = 2.081 (1.059-4.089), p = 0.033), and tumor location above duodenum (OR (95%CI) = 2.280 (1.445-3.596), p <  0.001) were associated with poor postoperative analgesia. CONCLUSIONS: The analgesic effects of PCIA with sufentanil in combination with flurbiprofen axetil and dexmedetomidine on postoperative analgesia was better than that of traditional pure opioids PCIA, and similar with that of PCEA.


Assuntos
Dexmedetomidina , Neoplasias Gastrointestinais , Analgésicos , Analgésicos Opioides , Flurbiprofeno/análogos & derivados , Neoplasias Gastrointestinais/cirurgia , Humanos , Metoclopramida , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Sufentanil
18.
BMC Psychiatry ; 22(1): 277, 2022 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-35443629

RESUMO

OBJECTIVE: The objective of the study is to explore the long-term effectiveness and tolerability of metoclopramide in the treatment of CIH. METHOD: This study is a retrospective, observational cohort study of patients prescribed metoclopramide for CIH at the South London & Maudsley (SLaM) NHS Foundation Trust. RESULTS: Of the 96 patients identified, 14 patients were eligible for inclusion in our study. Five patients continued treatment with a mean duration of 27 months (SD = 17.8), and one patient continued until transfer with a duration of 3 months. Eight patients discontinued treatment after a mean duration of 8 months. CONCLUSION: Metoclopramide may be an effective and tolerated drug in CIH, but more data is required to establish its place in the pharmacotherapy of this condition.


Assuntos
Antipsicóticos , Clozapina , Esquizofrenia , Sialorreia , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Humanos , Metoclopramida/efeitos adversos , Estudos Retrospectivos , Esquizofrenia/tratamento farmacológico , Sialorreia/induzido quimicamente , Sialorreia/tratamento farmacológico
19.
Front Endocrinol (Lausanne) ; 13: 832361, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35250884

RESUMO

INTRODUCTION: Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS: We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS: A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION: hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.


Assuntos
Neoplasias Hipofisárias , Síndrome do Ovário Policístico , Prolactinoma , Feminino , Humanos , Masculino , Metoclopramida , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Prolactinoma/complicações , Estudos Retrospectivos
20.
Nutr Clin Pract ; 37(4): 773-782, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35233831

RESUMO

OBJECTIVES: The objective was to compare the effects of prokinetic drugs on the success of postpyloric nasoenteric tube placement using network meta-analysis methods. MATERIALS AND METHODS: Articles from PubMed, Embase, and the Cochrane Library were retrieved up to April 18, 2021. Eligible studies were randomized controlled trials (RCTs) that investigated the effect of prokinetic drugs on postpyloric nasoenteric tube placement. Reviews, retrospective studies, observational studies, letters to the editors, and conference abstracts were excluded. Biases in each study were identified by using the tool recommended by the Cochrane Collaboration. Stata14.0 software were used to process the network meta-analysis. RESULTS: A total of 12 eligible RCTs with 777 patients receiving postpyloric nasoenteric tube placement were finally included for analysis. Patients receiving the following drugs appeared to have significant success with postpyloric feeding tube insertion compared with placebo: metoclopramide (odds ratio [OR] = 2.27; 95% CrI, 1.53-3.37), erythromycin (OR = 1.88; 95% CrI, 1.17-3.19), and domperidone (OR = 2.39; 95% CrI, 1.31-4.35). The surface under the cumulative ranking of placebo, erythromycin, metoclopramide, and domperidone were respectively 9.8%, 73.0%, 62.6%, and 54.6%. Erythromycin had an advantage over the other treatments in success postpyloric feeding tube insertion. CONCLUSIONS: Erythromycin may have the greatest possibility to improve success postpyloric feeding tube insertion.


Assuntos
Nutrição Enteral , Metoclopramida , Domperidona/uso terapêutico , Nutrição Enteral/métodos , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Humanos , Intubação Gastrointestinal/métodos , Metoclopramida/uso terapêutico , Metanálise em Rede
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...