The use of prokinetics/antiemetics is one of the leading causes of drug-induced parkinsonism (DIP) observed in neurology clinics. Cognitive dysfunction in DIP has recently been recognized, but pathologies related with cognitive dysfunction is unknown. Among our retrospective cohort of 385 consecutive parkinsonian patients enrolled in our parkinsonism registry, 14 patients were identified who satisfied our inclusion criteria: parkinsonism caused by prokinetics/antiemetics, existing T1-weighted 3D volumetric MR images, and normal [18F]-N-3-fluoropropyl-2-beta-carboxymethoxy-3-beta-(4-iodophenyl) nortropane PET scan images. For the comparison of volumetric MR data, 30 age- and sex-matched healthy individuals were included in this study. Among 14 patients with DIP, 4 patients were diagnosed with dementia, and all other patients had mild cognitive impairment (MCI). Comparisons of MR volumetric data between DIP patients with MCI and controls show that cortical gray matter volumes are reduced bilaterally in DIP (P=0.041) without changes in either total white matter volume or total intracranial volume. Among subcortical structures, the volume of the right hippocampus is reduced in DIP patients compared with controls (P=0.011, uncorrected). In DIP, cortical thickness is reduced in the bilateral lingual (P=0.002), right fusiform (P=0.032) and part of the left lateral occipital gyri (P=0.007). Our results suggests that cognitive dysfunction in DIP caused by prokinetics/antiemetics is common. Structural changes in the brain by 3D MRI may be associated with cognitive decline in DIP.
Aged ; Aged, 80 and over ; Antiemetics/*adverse effects ; Brain/drug effects/pathology ; Cognition Disorders/*chemically induced/*pathology ; Female ; Gastrointestinal Agents/*adverse effects ; Humans ; Male ; Parkinson Disease, Secondary/*chemically induced/*pathology ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Treatment Outcome

PURPOSE: We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT3)-receptor antagonist after the general anesthesia. MATERIALS AND METHODS: In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. RESULTS: Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. CONCLUSION: Despite antiemetic prophylaxis with 5 HT3-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
Adult ; Aged ; Analgesia, Patient-Controlled/*adverse effects ; Analgesics, Opioid/*adverse effects/therapeutic use ; Antiemetics/administration & dosage/therapeutic use ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Incidence ; Isoflurane/adverse effects/*analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Piperidines/*adverse effects/therapeutic use ; Postoperative Nausea and Vomiting/chemically induced/*epidemiology ; Retrospective Studies ; Risk Factors

OBJECTIVETo evaluate the efficacy and safety of nausea oral, disintegrating buccal tablet (DBT) in the prevention of gastrointestinal reaction induced by anticancer drugs (cisplatin DDP 30 - 50 mg/m(2) or adramycin ADM >/= 40 mg/m(2)), as compared with those of kytril tablets.

METHODSA multicenter, open and randomized self-crossover control trial was carried out with all the eligible patients randomized into AB or BA group. Patients in AB group were given nausea 0.1 mg as buccal tablet one hour before chemotherapy in the first cycle and kytril tablet 2 mg in the second cycle, those in BA group were given these drugs in the reverse order.

RESULTSSeventy-three patients were allotted to this study, including 44 patients in DDP-arm and 29 in ADM-arm. Sixty-two patients were evaluable for response and 70 patients for safety. Nausea DBT was as effective as kytril tablet in the control of anorexia, nausea and vomiting during the first 24 hours after chemotherapy, with response rates of 74.2%, 77.4%, 83.9% in nausea DBT and 74.2%, 71.0%, 88.7% DBT in kytril tablets. A high efficacy in the control of vommitting induced by cisplatin was observed in both nausea DBT and kytril tablets. The complete control rates and overall control rates were 83.3%, 91.7% in nausea DBT and 86.1%, 97.2% in kytril tablets, respectively. The side effects of nausea DBT were head heaviness, dry mouth and somnolence, which were mild and comparable with kytril in their frequencies.

CONCLUSIONNausea disintegrating buccal tablet is able to effectively prevent gastrointestinal reaction induced by anticancer drugs, with efficacy and side effects similar to kytril tablets. Nausea DB tablet, an intraoral disintegrator, is very convenient for patients who can not swallow tablets for various reasons.

Adolescent ; Adult ; Aged ; Antiemetics ; therapeutic use ; Antineoplastic Agents ; adverse effects ; Cisplatin ; adverse effects ; Digestive System ; drug effects ; Doxorubicin ; adverse effects ; Female ; Granisetron ; therapeutic use ; Humans ; Male ; Middle Aged ; Nausea ; chemically induced ; drug therapy ; Ondansetron ; Tablets ; Treatment Outcome ; Vomiting ; chemically induced ; drug therapy

OBJECTIVE: There is no research regarding the appropriate antiemetic agents for female patients, especially those receiving moderately emetogenic chemotherapy (MEC). We evaluated the antiemetic efficacy of a combination of 5-HT3 receptor with/without aprepitant in patients with gynecological cancer treated with the TC (paclitaxel and carboplatin) regimen of MEC. METHODS: We enrolled 38 patients diagnosed with gynecologic cancer and scheduled to receive the TC regimen. The patients were randomly assigned to receive a 5-HT3 receptor antagonist, either palonosetron in the first cycle followed by granisetron in the second cycle or vice versa. In the third cycle, all patients received a combination of the 5-HT3 receptor and dexamethasone with/without aprepitant. RESULTS: When three drugs were administered, palonosetron consistently produced an equivalent complete response (CR) rate to granisetron in the acute phase (89.5% vs. 86.8%, p=0.87) and delayed phase (60.5% vs. 65.8%, p=0.79). With regard to the change in dietary intake, palonosetron exhibited similar efficacy to granisetron in the acute phase (92.1% vs. 89.4%, p=0.19) and delayed phase (65.7% vs. 68.4%, p=0.14). However, in the delayed phase, the addition of aprepitant therapy with a 5-HT3 receptor antagonist and dexamethasone produced a higher CR rate than a 5-HT3 receptor antagonist with dexamethasone (93.3% vs. 47.8%, p<0.001) and allowed the patients to maintain a higher level of dietary intake (93.3% vs. 56.5%, p<0.001). CONCLUSION: The addition of aprepitant therapy was more effective than the control therapy of a 5-HT3 receptor antagonist, and dexamethasone in gynecological cancer patients treated with the TC regimen.
Adult ; Aged ; Antiemetics/*administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Carboplatin/administration & dosage/adverse effects ; Cross-Over Studies ; Diet ; Drug Administration Schedule ; Female ; Genital Neoplasms, Female/*drug therapy ; Granisetron/administration & dosage ; Humans ; Isoquinolines/administration & dosage ; Middle Aged ; Morpholines/administration & dosage ; Nausea/chemically induced/*prevention & control ; Paclitaxel/administration & dosage/adverse effects ; Quinuclidines/administration & dosage ; Serotonin 5-HT3 Receptor Antagonists ; Vomiting/chemically induced/*prevention & control

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS: We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS: In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION: Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.
Adult ; Analgesia, Patient-Controlled/*adverse effects ; Anesthetics, Intravenous/administration & dosage/adverse effects/therapeutic use ; Antiemetics/administration & dosage/therapeutic use ; Female ; Fentanyl/administration & dosage/adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postoperative Nausea and Vomiting/*drug therapy ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors

OBJECTIVEThe efficacies of the selective 5-hydroxytryptamine3 (5-HT3) antagonists--ramosetron (0.3 mg) and granisetron (3 mg) in treating acute chemotherapy-induced digestive system dysunction were compared.

METHODSA total of 111 patients were enrolled in a single-blind, randomised crossover study; with data from 98 were used to assess efficacy and data from 110 to assess the safety profile. Ramosetron or granisetron was given intraveneously 15 min befire chemotherpy.

RESULTSThe ability of ramosetron to prevent emesis, nausea and anorexia was similar to granisetron during the first 6 h following the administration of chemotherapy, ciplatin or doxorubicin. However, during the first 24 h after chemotherapy, significant differences between ramosetron and granisetron appeared: emetic episode (P = 0.068), nausea (P = 0.006), and anorexia (P = 0.048) remained lower in ramosetron-treated patients. The safety profile of ramosetron was similar to that of granisetron and adverse events in both groups were generally mild and transient.

CONCLUSIONRamosetron is more potent and longer-lasting than granisetron in preventing chemotherapy-induced digestive disturbances.

Adolescent ; Adult ; Aged ; Anorexia ; chemically induced ; drug therapy ; Antiemetics ; therapeutic use ; Antineoplastic Agents ; adverse effects ; Benzimidazoles ; therapeutic use ; Cisplatin ; adverse effects ; Cross-Over Studies ; Doxorubicin ; adverse effects ; Female ; Granisetron ; therapeutic use ; Humans ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged ; Nausea ; chemically induced ; prevention & control ; Serotonin Antagonists ; therapeutic use ; Single-Blind Method ; Vomiting, Anticipatory ; etiology ; prevention & control

It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics. A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group. Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p< or =0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p< or =0.001) in the high-risk group and from 61.3% to 28.3% (p< or =0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.
Adult ; Anesthetics/adverse effects ; Antiemetics/*pharmacology ; Dexamethasone/administration & dosage ; Female ; Humans ; Incidence ; Korea ; Middle Aged ; Ondansetron/administration & dosage ; Postoperative Complications/prevention & control ; Postoperative Nausea and Vomiting/*prevention & control ; Postoperative Period ; Risk ; Risk Factors ; Treatment Outcome

OBJECTIVETo observe the therapeutic efficacy of Hewei Zhiou Recipe (HZR) combined ondansetron hydrochloride (OH) in treating vomiting in children patients with solid tumor.

METHODSEighty children patients with solid tumor at the Department of Tumor, Beijing Children's Hospital from January 2007 to January 2010 were randomly assigned to the treatment group and the control group by the random digit table method, 40 in each group. OH 4 mg was intravenously dripped to patients in the control group. Those in the treatment group took HZR on the basis of the same treatment as for the control group. The vomiting score and degree of the two groups were collected and compared by the end of the 1st to the 6th therapeutic course.

RESULTSThere was no statistical difference in the vomiting degree between the two groups by the end of the 1st therapeutic course (Z = -0.470, P>0.05). The vomiting degree was lessened in the treatment group by the end of the 2nd to the 6th therapeutic course, showing statistical difference when compared with the control group (Z = - 2.966, -3.256, -3.453, -4.870, -3.627, respectively, P<0.01).

CONCLUSIONHZR combined OH could effectively relieve the vomiting of children patients with solid tumor during chemotherapy.

Antiemetics ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; Child ; Child, Preschool ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Neoplasms ; drug therapy ; Ondansetron ; therapeutic use ; Phytotherapy ; Vomiting ; chemically induced ; drug therapy

OBJECTIVETo observe therapeutic effect of acupuncture combined with antiemetic on cisplatin-induced nausea and vomiting.

METHODSBy using paired, cross-controlled trial design, 66 cases of chemotherapy were divided into group A and B, 33 cases in each group. For the group A, chemotherapy, tropisetron and acupuncture therapy were adopted in the first chemotherapy cycle and the same chemotherapy program, tropisetron and sham acupuncture were used in the next cycle. For the group B, chemotherapy, tropisetron and sham acupuncture were given in the first chemotherapy cycle and the same chemotherapy program, tropisetron and acupuncture therapy were applied in the next cycle. Zusanli (ST 36), Neiguan (PC 6) and Gongsun (SP 4) and auricular point Wei (stomach) were selected for acupuncture therapy, and the points at 3 cm lateral to Zusanli (ST 36) , Neiguan (PC 6) and Gongaun (SP 4) and auricular point corresponding to scapha level were selected for sham acupuncture. Acupuncture treatment or sham-acupuncture was given for 6 consecutive days, once each day and antiemetic tropisetron 5 mg was given to the two groups as basic antiemetic prophylaxis for 6 days, once daily. The therapeutic effects on nausea and vomiting in the 6 days were compared between the acupuncture group and the sham-acupuncture group in the two chemotherapeutic cycles.

RESULTSThe effective rates for nausea in the 2nd day and the 4th day were 87.1% and 79.0% in acupuncture group, which were superior to 59.4% and 57.8% in the sham-acupuncture group, respectively (both P < 0.05); and the therapeutic effects on vomiting in the 3rd-6th day in the acupuncture group were better than those in the sham-acupuncture group (P < 0.05).

CONCLUSIONAcupuncture combined with antiemetic can effectively decrease the incidence and degree of cisplatin-induced delayed nausea and vomiting. The effect of acupuncture is better than that of sham acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Antiemetics ; administration & dosage ; Breast Neoplasms ; complications ; drug therapy ; Cisplatin ; adverse effects ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; complications ; drug therapy ; Male ; Middle Aged ; Nausea ; drug therapy ; etiology ; therapy ; Vomiting ; drug therapy ; etiology ; therapy

OBJECTIVETo evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four (TOF) mode for the prevention of postoperative nausea and vomiting (PONV) in the patients undergoing laparoscopic cholecystectomy.

METHODSNinety-six ASA Grade I - II patients scheduled for laparoscopic cholecystectomy were randomized into Neiguan (P6) electroacupoint stimulation group (treated group) and a placebo control group (placement of electrodes without electroacupoint stimulation). The anesthetic regimen was standardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator. The incidence of nausea, vomiting, severity, antiemetic dosage and the degree of pain were assessed at 0, 60, 120 min, and 24 h after surgery.

RESULTSThe incidence of nausea and vomiting, the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation (P<0.05 or P<0.01).

CONCLUSIONTranscutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects.

Acupuncture Points ; Adult ; Antiemetics ; therapeutic use ; China ; epidemiology ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Incidence ; Intraoperative Period ; Male ; Pain ; pathology ; Postoperative Nausea and Vomiting ; drug therapy ; epidemiology ; prevention & control ; Transcutaneous Electric Nerve Stimulation ; methods