Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting / Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

RESUMO OBJETIVO: Estimar a incidência e avaliar os fatores de risco para náuseas e vômitos induzidos por antineoplásicos com alto e moderado potencial emético em pacientes adultos, no primeiro ciclo de tratamento. MÉTODOS: Estudo de coorte prospectiva, com 269 adultos acompanhados durante o primeiro ciclo de quimioterapia antineoplásica. A incidência de náuseas e vômitos foi avaliada na fase aguda (0-24 horas), na fase tardia (24 horas-5° dia) e na fase total (0-5° dia). RESULTADOS: 152 pacientes foram submetidos a quimioterápico com alto potencial emético e 117 a moderado potencial emético. A frequência relativa de náuseas foi maior quando comparada à de vômitos na fase aguda (p < 0,001) e na fase tardia (p < 0,001). Os fatores de risco identificados foram: faixa etária ≤ 49 anos (odds ratio = 0,47; IC95% 0,23-0,95) e 50-64 anos (odds ratio = 0,45; IC95% 0,23-0,87), uso de tabaco (odds ratio = 0,35; IC95% 0,14-0,88) e alto potencial emético dos quimioterápicos (odds ratio 0,55; IC95% 0,31-0,95). CONCLUSÃO: A incidência de náuseas foi maior do que a de vômitos, e na fase tardia os efeitos adversos foram mais frequentes. Os resultados sugerem que os fatores de risco para náuseas e vômitos induzidos por quimioterapia são o tabaco, a idade (adultos jovens) e o alto potencial emético do quimioterápico.

Incidence of nausea and vomiting after fast-track anaesthesia for heart surgery

Abstract Objective: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. Methods: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. Results: Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. Conclusion: PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.

Postoperative nausea and vomiting in the recovery room. A report from Guyana

Postoperative nausea and vomiting (PONV) in patients in the recovery room can delay transfer of such patients to the wards, preventing a smooth inflow of patients into the recovery area. The high incidence of these complications in developed countries has led to the introduction of management strategies that may be too expensive for developing countries. An investigation of the incidence and factors associated with PONV in the recovery room of the Public Hospital, Georgetown, Guyana, was undertaken with a view to developing an approach to its management based on local data. Seven hundred and sixty patients were studied. The majority (97) had general anaesthesia. Simple anaesthetic techniques involving agents of relatively low cost were used. Anti-emetics were infrequently administered. Only twenty-two patients (2.9) experienced PONV in the recovery room, all after general anaesthesia. Twenty-one of these (95) had risk factors for PONV in their history. PONV in the recovery room was associated with female gender, gynaecological surgery, extra-abdominal surgery and lack of anti-emetic medication (p < 0.05), as well as prolonged duration of recovery room stay (p < 0.01). A management strategy for PONV in the recovery room involving continued use of present anaesthetic agents, increased use of inexpensive anti-emetic drugs currently available in Guyana, and targeting of patients found to be more at risk is suggested. Increased regional techniques may also be appropriate.

Tratamento da cefaléia em uma unidade de emergência da cidade de Ribeiräo Preto / Headache treatment in an emergency room of the city of Ribeiräo Preto, Brazil

Cefaléia é dos sintomas mais comuns na prática clínica. Acarreta considerável impacto econômico e sobrecarrega as unidades de emergência. A maioria destas, em nosso país, não dispõe de triptans. O presente estudo analisa o tratamento instituído na Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto. Em 1996, 1254 pacientes foram atendidos com esta queixa e 64 necessitaram de internação. Dos pacientes não internados (NI), 77 por cento apresentavam cefaléias primárias, contra 29,7 por cento dos pacientes internados (I). A percentagem de melhora nos pacientes com migrânea com a dipirona endovenosa foi 83,8 por cento, com o diclofenaco intramuscular 66,7 por cento e com a clorpromazina (endovenosa) 81,8 por cento. As percentagens de pacientes com cefaléia do tipo tensinoal que melhoraram, frente às mesmas drogas foram, respectivamente 77,8 por cento, 80 por cento e 100 por cento. Dos NI 16,3 por cento tiveram melhora sem qualquer tratamento medicamentoso. Concluímos que as drogas utilizadas apresentam perfis semelhantes de eficácia e custo, podendo ser utilizadas em unidades básicas de saúde. O maior inconveniente é a administração parenteral.

Tratamiento y control total del dolor postoperatorio / Complete control of post-operative pain

Fue posible controlar el dolor postoperatorio en 50 pacientes que bajo anestesia general o peridural a quienes se les hizo cirugía electiva de ginecoobstetricia, urología y gastroenterología mediante la aplicación de 150 mcg de clorhidrato de buprenorfina por vía peridural o parenteral, conjuntamente con un analgésico anti-inflamatorio no esteroide por vía parenteral. La incidencia de náusea y vómito fue mínima y fácil de controlar con antieméticos tradicionales. Cuatro individuos refirieron somnolencia que se incrementó discretamente cuando se les administró dehidrobenzoperidol. Fue evidente la ausencia de dolor postoperatorio. Todos manifestaron evolución postoperatoria significativamente mejor que en experiencias quirúrgicas anteriores