Comparison of dexamethasone and ondansetron in the prophylaxis of emesis induced by moderately emetogenic chemotherapy

Jones, Alison; Hill, A; Soukop, M.; Hutcheon, A. W.; Cassidy, Jim; Kaye, Stanley B.; Sikora, Karol; Carney, Desmond N.; Cunningham, David

doi:10.1016/0140-6736(91)90554-3

Cited by 200 publications

(74 citation statements)

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“…The effect on nausea is less well researched, being more difficult to evaluate. However, complete control of nausea and emesis is not achieved in every patient (Jones et al, 1991;Smith et al, 1991;Smyth et al, 1991) and it would be worthwhile to examine the prevalence of anticipatory nausea and emesis where a 5HT3 anti-emetic is in use. The low numbers of patients on this type of anti-emetic, in the present study, precluded any detailed examination of these effects.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it is assumed that with the advent of the 5-hydroxytryptamine3 (5-HT3) antagonists, not only will post-treatment side-effects be controlled, but anticipatory symptoms should become a thing of the past. However, control using 5-HT3 drugs is not always complete (Jones et al, 1991;Smyth et al, 1991) and as yet there are no published studies which examine the prevalence of an anticipatory nausea and emesis response where 5HT3, drugs were used, although clearly such studies are needed.The most widely accepted explanation for anticipatory/ psychologically-based nausea and emesis is that it is a conditioned (i.e. learnt) response.…”

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confidence: 99%

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Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

McCarron¹,

Law²

1992

Br J Cancer

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Summary The prevalence of nausea and emesis among a series of out-patients (n = 95) receiving mainly mildto moderately-emetic cytotoxics, was assessed, along with levels of psychological morbidity. Particular focus was given to the rates of psychologically-based (anticipatory) nausea and emesis. Results indicated that 23% of patients experienced anticipatory nausea and the majority reported that this occurred before at least half of the previous treatment cycles. Both There is also an increasing literature showing that some patients receiving CT develop psychologically-based nausea and emesis (Watson & Marvell, 1991). Although this may occur before, during or after administration of CT most studies examine anticipatory symptoms, as the psychological effect is more difficult to distinguish from purely drug-related effects at other times. However, post-treatment nausea and emesis which is out of proportion to the emetic challenge of the CT drugs may well indicate a psychological element and this effect is less well researched.Although occurring less commonly than post-treatment nausea and emesis, the importance of the anticipatory sideeffect lies in its intractability once established and the fact that it may continue after CT administration has ceased, with some patients feeling nauseous when they return for followup out-patient appointments (Hughson & Cooper, 1988). Furthermore, it is assumed that with the advent of the 5-hydroxytryptamine3 (5-HT3) antagonists, not only will post-treatment side-effects be controlled, but anticipatory symptoms should become a thing of the past. However, control using 5-HT3 drugs is not always complete (Jones et al., 1991;Smyth et al., 1991) and as yet there are no published studies which examine the prevalence of an anticipatory nausea and emesis response where 5HT3, drugs were used, although clearly such studies are needed.The most widely accepted explanation for anticipatory/ psychologically-based nausea and emesis is that it is a conditioned (i.e. learnt) response. Neutral stimuli present at the time of CT administration, and associated with the druginduced effect, acquire the ability to trigger nausea and/or emesis during subsequent treatment cycles, even when the drug has not yet been administered. In psychological terms this is a very simple learning paradigm and the effect has also been observed in sub-humans.A number of studies have drawn attention to the possible role of anxiety as a contributory factor (Altmaier et al., 1982;Andrykowski et al., 1985;Nerenz et al., 1986). It is intuitively appealing to explain psychologically-based nausea and emesis in terms of 'nerves' yet it is clear from Andrykowski's recent review (1990) Other possible risk factors potentiating psychologicallybased nausea and emesis include a tendency to travel sickness in adulthood, and younger age (Morrow et al., 1991). The clearest contributor, however, is thought to be severe and long-lasting nausea and emesis following previous CT infusions. Thus it is likely that the toxicity of the drug re...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

McCarron¹,

Law²

1992

Br J Cancer

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“…4 Dexamethasone has been used as an antiemetic drug in patients undergoing chemotherapy with limited side effects. 5 Recently, it has been found to have a prophylactic effect on postoperative vomiting in children undergoing tonsillectomy. 6 Dexamethasone has combined antiemetic and anti-inflammatory effects that may decrease postoperative tissue injury, edema and pain after electrocautery tonsillectomy.…”

Section: Me Et Th Ho Od Ds S:mentioning

confidence: 99%

Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy

Elhakim

Rashed

et al. 2003

Can J Anesth/J Can Anesth

145

121

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P Pu ur rp po os se e: : Previous studies on dexamethasone's antiemetic and analgesic potential in children undergoing tonsillectomy have produced conflicting results. The aim of this study was to evaluate the effects of a single dose of dexamethasone on the incidence and severity of postoperative vomiting and pain in children undergoing electrocautery tonsillectomy under standardized general anesthesia. M Me et th ho od ds s: :In a double-blinded study, 120 patients were randomly allocated to receive either dexamethasone 0.5 mg·kg -1 (maximum dose 8 mg) iv or an equivalent volume of saline preoperatively. The incidence of early and late vomiting, need for rescue antiemetics, time to first oral intake, time to first demand of analgesia and analgesic consumption were compared in both groups. Pain scores used included Children's Hospital Eastern Ontario Pain Scale, "faces", and a 0-10 visual analogue pain scale.R Re es su ul lt ts s: : Compared with placebo, dexamethasone significantly decreased the incidence of early and late vomiting (P < 0.05, P < 0.001 respectively). Fewer patients in the dexamethasone group needed antiemetic rescue (P < 0.01). The time to first oral intake was shorter, and the time to first dose of analgesic was longer in the dexamethasone group (P < 0.01). Pain scores 30 min after extubation were lower (P < 0.05) in the dexamethasone group. At 12 and 24 hr postoperative swallowing was still significantly less painful in the dexamethasone group than in the control group (P < 0.01).C Co on nc cl lu us si io on n: : Preoperative dexamethasone 0.5 mg·kg -1 iv reduced both postoperative vomiting and pain in children after electrocautery tonsillectomy. ONSILLECTOMY is one of the most frequently performed ambulatory surgical procedures in children and is associated with an incidence of postoperative vomiting ranging between 40% and 73%. 1-3 The introduction of an electrodissection surgical technique has virtually eliminated immediate postoperative hemorrhage. However, it may cause more pain, discomfort Résultats : Comparée au placebo, la dexaméthasone a significativement réduit l'incidence de vomissements précoces et tardifs (P < 0,05, P < 0,001 respectivement). Peu de patients ayant reçu la dexaméthasone ont eu besoin d'antiémétique de secours (P < 0,01

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“…24 h. Les vomissements se produisant jusqu'~ deux heures apr~s l'intervention &aient consid&& comme des vomissements pr&oces et ceux qui survenaient entre 2 et 24 h, comme des vomissements tardifs. ~,.stfltats : Le score des naus6es postop&atoires 6tait plus has chez les patientes qui avaient regu une combinaison d'ondans~tron et de dexam~thasone (3,76) plut6t que de l'ondans&ron seulement (4,38) ~ 0 h (P < 0,0 I), ~ 2 h (P < 0,05) et ~ 24 h (P < 0,0 I). Darts le groupe I, 38,5 % des patientes ont pr&ent~ un score de naus~es 5 (naus~es importantes) comparativement ~ 12 % seulement des patientes dans le groupe 2 (P < 0,025).…”

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Comparison of ondansetron with ondansetron and dexamethasone in prevention of PONV in diagnostic laparoscopy

Rajeeva

Bhardwaj

Batra

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV). Methods: This double blind, randomized study was carried out in 51 female patients, aged 20-40 yr, ASA-I physical status undergoing gynecological diagnostic laparoscopy. Group I (n = 26) received 4mg ondansetron iv and group 2 (n = 25) received a combination of 4 mg ondansetron and 8 mg dexamethasone iv soon after induction of anesthesia. Postoperatively patients were assessed hourly for four hours and then at 24 hr for nausea, vomiting, pain and post anesthetic discharge score. Vomiting occurring up to two hours was considered early vomiting and from 2-24 hr as delayed vomiting. Results: The postoperative nausea score was lower in patients receiving a combination of ondansetron and dexamethasone (3.76) than ondansetron alone (4.38) at 0 hr (P < 0.01), 2 hr (P < 0.05) and 24 hr (P < 0.0 I). In group I, 38.5% of patients had a nausea score of ~ 5 (major nausea) compared with only 12% of patients in group 2 (P < 0.025). The overall incidence of vomiting was greater in group I (35%) than in group 2 (8%) (P < 0.05). The combination group showed better control of delayed vomiting compared with the ondansetron group (4% vs 35%) (P < 0.0 I). Conclusion: The combination of ondansetron and dexamethasone provides adequate control of PONV, with delayed PONV being better controlled than early PONV. ~,.stfltats : Le score des naus6es postop&atoires 6tait plus has chez les patientes qui avaient regu une combinaison d'ondans~tron et de dexam~thasone (3,76) plut6t que de l'ondans&ron seulement (4,38) ~ 0 h (P < 0,0 I), ~ 2 h (P < 0,05) et ~ 24 h (P < 0,0 I). Darts le groupe I, 38,5 % des patientes ont pr&ent~ un score de naus~es 5 (naus~es importantes) comparativement ~ 12 % seulement des patientes dans le groupe 2 (P < 0,025). ~incidence totale de vomissements &ait plus grande darts le groupe I (35 %) que darts le groupe 2 (8 %) (P < 0,05). Le groupe ayant regu une combinaison de m~dicaments, compar~ au groupe qui a re~ju de l'ondans&ron, a pr&ent~ un meilleur contr61e des vomissements tardifs (4 % vs 35 %) (P < 0,0 I). Conclusion : La combinaison d'ondans&ron et de dexam&hasone fournit un bon contr61e des NVPO, meilleur pour les NVPO pr&oces que pour les NVPO tardifs.

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Comparison of dexamethasone and ondansetron in the prophylaxis of emesis induced by moderately emetogenic chemotherapy

Cited by 200 publications

References 19 publications

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy

Comparison of ondansetron with ondansetron and dexamethasone in prevention of PONV in diagnostic laparoscopy

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