Complementary Intervention in Postoperative Care: Aromatherapy's Role in Decreasing Postoperative Nausea and Vomiting

Purpose: This study analyzed the efficacy of Post-Ease, a custom essential oil aromatherapy blend, in decreasing postoperative nausea and vomiting (PONV) and the need for antiemetic drugs in an orthopaedic surgical population. Study Design: This is retrospective cohort study, utilizing electronic health record data pre- and post-implementation of a nurse-driven quality improvement intervention. Methods: The study examined the impact of an inhaled custom blend of essential oils containing lavender, peppermint, ginger and lemon to assist in decreasing PONV and reduce the use of antiemetic medications. Data on the use of antiemetic drugs in pre- and post-intervention periods were analyzed. Findings: Nurses provided the Post-Ease blend 384 times in 2020 to patients as an option before proceeding, if necessary, to antiemetic drugs. The intervention group demonstrated a statistically significant reduction in the number of unique surgical patients’ need for antiemetics as treatment (22%; p = .05). Similarly, the total doses of antiemetics administered was significantly reduced (21%; p ≤ .05) during the study period. Conclusion: This study supports the use of aromatherapy to reduce PONV and minimize antiemetic use in an orthopaedic population.

The effect of progressive muscle relaxation training on chemotherapy-induced nausea, vomiting and anxiety in Egyptian breast cancer women: A randomized controlled trial

Background and objective: This study was conducted to examine the effect of progressive muscle relaxation training (PMRT) in combination with antiemetic drugs on chemotherapy-associated nausea, vomiting and anxiety in breast cancer women receiving chemotherapy.Methods: A randomized controlled trial design was conducted on 74 patients divided into control (n = 37) and PMRT group (n = 37). The study was conducted at Oncology Center affiliated to Mansoura University, Egypt. The intervention included daily PMRT practice for seven days two hours before chemotherapy. The patients exercised in the oncology unit with the researcher, and individually applied the exercises at home. The data was collected using Rhodes index of nausea-vomiting and retching used daily after chemotherapy for seven days and Zung self-rating anxiety scale used before chemotherapy and at the seventh and 14th days after chemotherapy.Results: A significant decrease in the frequency, severity, and duration of vomiting, nausea, retching and anxiety in PMRT group than in the control group (p < .0001). Conclusions: Progressive muscle relaxation combined with antiemetics was effective in reducing vomiting, nausea, and retching, as well as improving anxiety level induced by chemotherapy.

Marketing Analysis: Antiemetic Drugs on the Pharmaceutical Market of Uzbekistan

In this study, we analysed, with the help of the “State Register of Medicines, Medical Devices and Medical Equipment Permitted for Use in Medical Practice of the Republic of Uzbekistan”, the number, dosage forms and cost of registered antiemetic drugs in 2016-2020 based on the DRUG AUDIT program, which offers a database of information from 2016 to 2020.

Pilot Implementation of the Competence of Czech Paramedics to Administer Sufentanil for the Treatment of Pain in Acute Trauma Without Consulting a Physician: Observational Study

BackgroundThe use of intravenous opioids in the traumatic pain in pre-hospital care in the Czech Republic is based primarily on the indication of a physician. If the paramedic crew arrives at the site earlier or only on their own, analgesia is given after phone-call consultation with the physician or after his arrival at the site. The objective of this study was to evaluate the safety and efficacy of the indication and administration of sufentanil by paramedics in the treatment of pain in acute trauma adult patients without the physician’s control. MethodsParamedics underwent voluntarily the simulation training aimed at administering intravenously sufentanil to treat pain in acute trauma in adults without physician’s indication. Subsequently, the adverse events and efficacy were monitored for a six-month period and compared in two groups: administration of sufentanil by paramedics without this competence, who further consulted the administration by telephone with physicians (group Consultation) and those with this competence (group Competence).ResultsA total number of sufentanil administration in group Consultation was 88 and in group Competence 70. There was no respiratory arrest, bradypnea, or need for oxygen therapy reported in any of the study groups. The incidence of nausea was the same 3% in Consultation; (n = 3) and in Competence (n = 2). Vomiting was not reported in the Consultation group and in 6% in the Competence group (n = 4). Intravenous antiemetic drugs were used in the Consultation group only in 1% (n = 1) and in the Competence group in 7% of patients (n = 5) (p < 0,05). In both groups there was observed a decrease in the numeric rating scale (Consultation: M = - 3,2; SD = 1,2 points vs. Competence: M = - 3,9; SD = 1,8 points). ConclusionIntravenous administration of sufentanil by properly trained paramedics without consultation with a physician in acute trauma can be considered safe.

Obtaining and research of pharmaceutical properties of antiemetics in a form of powder for inhalation

Samples of antiemetic drugs (ondansetronum, palonosetronum, metoclopramidum) in the form of powder for inhalation have been developed by the method of spray drying. The granulometric composition, hygroscopicity and aerodynamic distribution of aerosol particles of the drugs have been investigated. The dosage form of the powder for inhalation of antiemetics (ondansetronum and palonosetronum) in terms of its particle size distribution, hygroscopicity and content of the agent corresponds to those for inhalation using dry powder inhalers. In the study of the phase-dispersed composition of aerosol, ondansetronum and palonosetronum in the dosage form of powder for inhalation as part of the HandiHaler inhaler (at a flow rate of 60 l / min) showed high rates of the released dose up to 72-76%, respirable particle fraction (up to 5 m) up to 54 -56% and a mass median particle size of about 3 microns. Obtaining the inhaled form of metoclopramide requires optimization of the production method for receiving the product with acceptable pharmaceutical properties.

Preparing for medical education after the COVID-19 pandemic: insightology in medicine

It is necessary to reflect on the question, “How to prepare for medical education after coronavirus disease 2019 (COVID-19)?” Although we are preparing for the era of Education 4.0 in line with the 4th industrial revolution of artificial intelligence and big data, most measures are focused on the methodologies of transferring knowledge; essential innovation is not being addressed. What is fundamentally needed in medicine is insightful intelligence that can see the invisible. We should not create doctors who only prescribe antispasmodics for abdominal pain, or antiemetic drugs for vomiting. Good clinical reasoning is not based on knowledge alone. Insightology in medicine is based on experience through Bayesian reasoning and imagination through the theory of mind. This refers to diagnosis of the whole, greater than the sum of its parts, by looking at the invisible using the Gestalt strategy. Identifying the missing process that links symptoms is essential. This missing process can be described in one word: context. An accurate diagnosis is possible only by understanding context, which can be done by standing in someone else’s shoes. From the viewpoint of medicine, Education 4.0 is worrisome because people are still clinging to methodology. The subject we should focus on is “human”, not “artificial” intelligence. We should first advance the “insightology in medicine” as a new paradigm, which is the “essence” that will never change even when rare “phenomena” such as the COVID-19 outbreak occur. For this reason, we should focus on teaching insightology in medicine, rather than teaching medical knowledge.

In Vitro Inhibition of Renal OCT2 and MATE1 Secretion by Antiemetic Drugs

The organic cation transporter 2 (OCT2) and multidrug and toxin extrusion protein 1 (MATE1) mediate the renal secretion of drugs. Recent studies suggest that ondansetron, a 5-HT3 antagonist drug used to prevent nausea and vomiting, can inhibit OCT2- and MATE1-mediated transport. The purpose of this study was to test the ability of five 5-HT3 antagonist drugs to inhibit the OCT2 and MATE1 transporters. The transport of the OCT2/MATE1 probe substrate ASP+ was assessed using two models: (1) HEK293 kidney cells overexpressing human OCT2 or MATE1, and (2) MDCK cells transfected with human OCT2 and MATE1. In HEK293 cells, the inhibition of ASP+ uptake by OCT2 listed in order of potency was palonosetron (IC50: 2.6 μM) > ondansetron > granisetron > tropisetron > dolasetron (IC50: 85.4 μM) and the inhibition of ASP+ uptake by MATE1 in order of potency was ondansetron (IC50: 0.1 μM) > palonosetron = tropisetron > granisetron > dolasetron (IC50: 27.4 μM). Ondansetron (0.5–20 μM) inhibited the basolateral-to-apical transcellular transport of ASP+ up to 64%. Higher concentrations (10 and 20 μM) of palonosetron, tropisetron, and dolasetron similarly reduced the transcellular transport of ASP+. In double-transfected OCT2-MATE1 MDCK cells, ondansetron at concentrations of 0.5 and 2.5 μM caused significant intracellular accumulation of ASP+. Taken together, these data suggest that 5-HT3 antagonist drugs may inhibit the renal secretion of cationic drugs by interfering with OCT2 and/or MATE1 function.

Effects of High and Normal Dose Fluid Therapy on Nausea and Vomiting after Pediatric Tonsillectomy: A Comparative Study

Background: Nausea, vomiting, and postoperative pain are common and undesirable complications after anesthesia and tonsillectomy surgery especially in children. This study was designed to evaluate the effects of high and normal dose lactated Ringer infusion on nausea, vomiting, and pain intensity after pediatric tonsillectomy. Methods: A total number of 100 tonsillectomy surgery candidates at the age range of 1-12 years were selected for this randomized clinical trial. The subjects were randomly assigned to the intervention or control group after signing of their informed consent. The intervention group received high-dose fluid therapy (lactated Ringer 30cc/kg) and the control group received the normal dose (lactated Ringer 10cc/kg) during the perioperative period. The amounts of consumed adjuvant antiemetic drugs, incidence of nausea and vomiting, and pain severity were evaluated in both groups in the recovery room, at 12 and 24 hours after tonsillectomy. Results: The incidence of nausea and vomiting and the use of rescue antiemetic drugs in the intervention group compared to the control group, were always lower in the recovery room, 12 and 24 hours after surgery; but only the difference in incidence of nausea and vomiting at 24 hours after surgery was statistically significant (P = 0.027). Conclusion: High-dose fluid therapy significantly reduces the late incidence (24 hours after surgery) of post- tonsillectomy nausea and vomiting in children.

Effect of dexamethasone on reducing pain and gastrointestinal symptoms associated with cesarean section: a systematic review and meta-analysis

Background: Dexamethasone has analgesic and antiemetic actions that have been documented in the literature. Therefore, we performed a systematic review and meta-analysis to investigate its overall effectiveness in reducing a variety of negative outcomes after cesarean section. Objectives: To investigate the efficacy and safety of dexamethasone for reducing pain associated with cesarean section, nausea, vomiting, pruritus, postoperative need for analgesia, postoperative antiemetic requests and headache. Methods: We searched PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science for relevant clinical trials. We then performed a systematic review and meta-analysis, including only randomized, placebo-controlled clinical trials. Our main population target was women undergoing elective cesarean delivery. The intervention under consideration was dexamethasone administered both by intravenous (IV) or subcutaneous (SC) over a variety of doses. The comparator was a placebo. Our main outcomes included: (1) perceptions as indicated by pain scores, (2) occurrence of nausea and (3) occurrence of vomiting. Secondary outcomes included: (4) occurrence of pruritus, (5) need for postoperative analgesia, (6) need for postoperative antiemetic drugs and (7) occurrence of headache. We assessed the quality of included studies using the risk of bias tool described in Cochrane's handbook for systematic reviews of interventions. Results: We found that dexamethasone seemed to significantly reduce scores for pain at rest (p<0.001), as well as occurrence of nausea (p<0.001) and vomiting (p<0.001). The drug also showed significant reduction of negative symptoms in other secondary outcomes, including need for postoperative analgesia (p<0.001) and postoperative antiemetic drugs (p<0.001). However, the drug showed no significant effect in reducing headache and pruritus or in improving pain at movement scores. Conclusion: Dexamethasone appears to decrease perception of pain at rest and protects against nausea and vomiting. However, it does not seem effective against headaches or pruritus.