RESUMO
BACKGROUND: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. METHODS: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. RESULTS: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). CONCLUSIONS: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.
Assuntos
Anestesia Geral , Antieméticos , Olanzapina , Náusea e Vômito Pós-Operatórios , Humanos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Olanzapina/uso terapêutico , Olanzapina/efeitos adversos , Antieméticos/uso terapêutico , Anestesia Geral/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Nausea is an uncomfortable sensation that accompanies many therapeutics, especially diabetes treatments involving glucagon-like peptide-1 receptor (GLP1R) agonists. Recent studies in mice have revealed that GLP1R-expressing neurons in the area postrema play critical roles in nausea. Here, we characterized a ligand-conjugated saporin that can efficiently ablate GLP1R+ cells from humans, mice, and the Suncus murinus, a small animal model capable of emesis. This new tool provides a strategy to manipulate specific neural pathways in the area postrema in the Suncus murinus and may help elucidate roles of area postrema GLP1R+ neurons in emesis during therapeutics involving GLP1R agonists.
Assuntos
Área Postrema , Receptor do Peptídeo Semelhante ao Glucagon 1 , Animais , Humanos , Camundongos , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Náusea , Neurônios/metabolismo , Vômito/metabolismo , MusaranhosRESUMO
Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.
RESUMO
Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient's quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.
Assuntos
Antieméticos , Antineoplásicos , Neoplasias , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Humanos , Náusea/induzido quimicamente , Náusea/prevenção & controle , Neoplasias/tratamento farmacológico , Qualidade de Vida , Vômito/induzido quimicamente , Vômito/prevenção & controleRESUMO
Embora atualmente existam maneiras de prevenção contra a parvovirose, tal patologia ainda preocupa a comunidade veterinária, pois trata-se de uma zoonose extremamente contagiosa, que, em geral, acomete animais jovens. Seus principais sinais clínicos são hematêmese e fezes diarreicas de conteúdo sanguinolento, podendo levar à confusão diagnóstica com gastroenterites bacterianas e virais, como cinomose e salmonelose. Deste modo, torna-se de suma importância que os médicos veterinários tenham total domínio dos conhecimentos sobre a parvovirose, e que promovam também educação em saúde em meio aos propritários.(AU)
Although there are currently ways to prevent parvovirus infection, this pathology is still of concern to the veterinary community, as it is an extremely contagious zoonosis, which usually affects young animals. Its main clinical signs are hematemesis and bloody diarrheal stools, which can lead to diagnostic confusion with bacterial and viral gastroenteritis such as distemper and salmonellosis. It is therefore of paramount importance that veterinary practitioners should have full knowledge of parvovirus disease and that they should also promote health education among their staff.(AU)
Assuntos
Animais , Infecções por Parvoviridae/veterinária , Doenças do Cão/diagnóstico , Cães/virologia , Parvoviridae , Hematemese/veterinária , Gastroenterite/fisiopatologiaRESUMO
ABSTRACT BACKGROUND: The Health-Related Quality of Life Questionnaire for Nausea and Vomiting of Pregnancy (NVPQOL) is a validated questionnaire assessing quality of life among pregnant women with nausea and vomiting. OBJECTIVE: To translate, cross-culturally adapt and evaluate the reliability of the NVPQOL. DESIGN AND SETTING: Observational cross-sectional study developed in a public university in Brazil. METHODS: The translation, synthesis of translations, back-translation, expert committee, pre-testing and validation were carried out, resulting in a Portuguese-language version. The internal consistency, intra-rater and test-retest reliability and correlation between the total score of the Portuguese-language version of the NVPQOL and the domains of the World Health Organization Quality of Life-bref questionnaire were considered in the data analysis. RESULTS: The instrument went through the process with testing on 104 pregnant women. Strong internal consistency (Cronbach's α: 0.95), strong intra-rater and test-retest reliability (P < 0.0; intraclass correlation coefficient: 0.89; confidence interval: 0.791-0.945) and strong correlation between the total score of the Portuguese-language version of the NVPQOL and the physical health domain of the World Health Organization Quality of Life-bref questionnaire (P < 0.01; R = −0.8) were observed. CONCLUSION: The NVPQOL was translated, cross-culturally adapted and validated for the Portuguese language with satisfactory psychometric properties for assessing quality of life, especially in relation to physical health, among pregnant women with symptoms of nausea and vomiting in the first trimester of pregnancy.
Assuntos
Humanos , Feminino , Gravidez , Qualidade de Vida , Comparação Transcultural , Psicometria , Traduções , Vômito , Brasil , Estudos Transversais , Inquéritos e Questionários , Reprodutibilidade dos Testes , NáuseaRESUMO
O vômito é um reflexo protetor complexo mediado pelo centro emético, região do sistema nervoso central, que recebe impulsos provenientes de outros e a noradrenalina são os principais mediadores do vômito, tendo a histamina, a dopamina, a acetilcolina e as encefalinas um papel secundário. Em vista de variações na fisiologia do vômito e na farmacologia entre as espécies, ressalta-se a importância de estudos focados em felinos. Entre os agentes indutores do vômito, os adrenérgicos alfa-2 agonistas, de que são exemplos a dexmedetomidina e a xilazina, são os mais estudados na espécie com essa finalidade. O maropitant e a ondansetrona estão entre os fámacos antieméticos mais recentes. A mirtazapina pode ter utilidade na prevenção do vômito crônico.
Vomiting is a complex protective reflex mediated by the emetic center, a region of the central nervous system that receives impulses from other central and peripheral afferent areas. In cats, substance P, serotonin and norepinephrine are the main mediators of vomiting, with histamine, dopamine, acetylcholine, and enkephalins having a secondary role. In view of variations in the physiology of vomiting and pharmacology across species, the importance of studies focused on felines is emphasized. Among the emetic agents, alpha-2-adrenergic agonists, such as dexmedetomidine and xylazine, are the most studied in the species for this purpose. Maropitant and ondansetron are the more recent antiemetic drugs. Mirtazapine may be useful to prevent chronic vomiting.
El vómito es un reflejo protector complejo mediado por el centro del vómito, una región del sistema nervioso central que recibe impulsos de otras áreas centrales y periféricas aferentes. En los gatos, los principales mediadores de la emesis son la sustancia P, la serotonina y la noradrenalina, mientras que la histamina, la dopamina, la acetilcolina y las encefalinas cumplen un papel secundario. Teniendo en cuenta que la fisiología y la farmacología del vómito varían de acuerdo a las diferentes especies, cabe resaltar la importancia de ciertos estudios realizados en felinos. Entre los agentes inductores del vómito más estudiados en felinos están los adrenérgicos alfa-2 agonistas como dexmedetomidina y xilacina. El maropitant y el ondansetron se encuentran entre los fármacos más recientemente introducidos. La mirtazapin puede ser útil en la prevención del vómito crónico.
Assuntos
Animais , Gatos , Fenômenos Farmacológicos , Gatos , Vômito/diagnóstico , Vômito/veterináriaRESUMO
O vômito é um reflexo protetor complexo mediado pelo centro emético, região do sistema nervoso central, que recebe impulsos provenientes de outros e a noradrenalina são os principais mediadores do vômito, tendo a histamina, a dopamina, a acetilcolina e as encefalinas um papel secundário. Em vista de variações na fisiologia do vômito e na farmacologia entre as espécies, ressalta-se a importância de estudos focados em felinos. Entre os agentes indutores do vômito, os adrenérgicos alfa-2 agonistas, de que são exemplos a dexmedetomidina e a xilazina, são os mais estudados na espécie com essa finalidade. O maropitant e a ondansetrona estão entre os fámacos antieméticos mais recentes. A mirtazapina pode ter utilidade na prevenção do vômito crônico.(AU)
Vomiting is a complex protective reflex mediated by the emetic center, a region of the central nervous system that receives impulses from other central and peripheral afferent areas. In cats, substance P, serotonin and norepinephrine are the main mediators of vomiting, with histamine, dopamine, acetylcholine, and enkephalins having a secondary role. In view of variations in the physiology of vomiting and pharmacology across species, the importance of studies focused on felines is emphasized. Among the emetic agents, alpha-2-adrenergic agonists, such as dexmedetomidine and xylazine, are the most studied in the species for this purpose. Maropitant and ondansetron are the more recent antiemetic drugs. Mirtazapine may be useful to prevent chronic vomiting.(AU)
El vómito es un reflejo protector complejo mediado por el centro del vómito, una región del sistema nervioso central que recibe impulsos de otras áreas centrales y periféricas aferentes. En los gatos, los principales mediadores de la emesis son la sustancia P, la serotonina y la noradrenalina, mientras que la histamina, la dopamina, la acetilcolina y las encefalinas cumplen un papel secundario. Teniendo en cuenta que la fisiología y la farmacología del vómito varían de acuerdo a las diferentes especies, cabe resaltar la importancia de ciertos estudios realizados en felinos. Entre los agentes inductores del vómito más estudiados en felinos están los adrenérgicos alfa-2 agonistas como dexmedetomidina y xilacina. El maropitant y el ondansetron se encuentran entre los fármacos más recientemente introducidos. La mirtazapin puede ser útil en la prevención del vómito crónico.(AU)
Assuntos
Animais , Gatos , Gatos , Vômito/diagnóstico , Vômito/veterinária , Fenômenos FarmacológicosRESUMO
OBJECTIVES: To synthesize quantitative and qualitative data on pharmacologic interventions of pediatric cyclic vomiting syndrome and their effectiveness in disease management in the acute care setting. STUDY DESIGN: Using keywords, 799 studies published up from December 1954 to February 2018 were extracted from MEDLINE via Pubmed, Embase via OVID, CINAHL via EBSCO, and Cochrane Controlled Trials Registry. Studies were evaluated for inclusion and exclusion by 2 independent reviewers using predetermined inclusion and exclusion criteria. RESULTS: The search yielded 84 studies for full review, of which 54 were included in the systematic review. Studies were subsequently separated into 1 group of 6 case series studies containing quantitative data on sumatriptan, ondansetron, phenothiazines, prokinetic agents, carbohydrate, isometheptene, and aprepitant; 1 one group consisting only of qualitative studies containing expert recommendations. CONCLUSIONS: Ondansetron has the most quantitative and qualitative evidence to support its inclusion in pediatric emergency department protocols as a rescue therapy. Sumatriptan and aprepitant are potential candidates for inclusion as abortive therapies. Qualitative data from retrospective studies and case reports are not applicable to a larger patient population. This report informs a need for controlled, prospective cohort studies and randomized, controlled trials to optimize current management protocols and to develop new medical interventions.
Assuntos
Cuidados Críticos/métodos , Gerenciamento Clínico , Vômito/terapia , Criança , HumanosRESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the incidence of vomiting was assessed. There was no significant difference between groups on the incidence of vomiting recorded in Phase 1, Phase 2 and the average of Phases 1 and 2. A significant decrease in PR was observed in most groups but no significant difference was detected between groups. Blood pressure decreased in all groups; during most of the evaluation period, SAP, MAP and DAP were significantly higher in the Control than in other treatments. Dogs in this study presented mild to intense sedation.[...]
Assuntos
Animais , Cães , Acepromazina/administração & dosagem , Acepromazina/uso terapêutico , Morfina/efeitos adversos , Neuroleptanalgesia/veterinária , Analgésicos Opioides , Vômito/veterináriaRESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the in
RESUMO
Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the incidence of vomiting was assessed. There was no significant difference between groups on the incidence of vomiting recorded in Phase 1, Phase 2 and the average of Phases 1 and 2. A significant decrease in PR was observed in most groups but no significant difference was detected between groups. Blood pressure decreased in all groups; during most of the evaluation period, SAP, MAP and DAP were significantly higher in the Control than in other treatments. Dogs in this study presented mild to intense sedation.[...](AU)
Assuntos
Animais , Cães , Acepromazina/administração & dosagem , /veterinária , Acepromazina/uso terapêutico , Morfina/efeitos adversos , Neuroleptanalgesia/veterinária , Analgésicos Opioides , Vômito/veterináriaRESUMO
Chemotherapy-induced nausea and vomiting is one of the most worrisome adverse effects of chemotherapy for cancer patients. It can cause severe discomfort and affect the quality of life. In recent years, the incorporation of new drugs has increased the efficacy of antiemetic treatments in the control of emesis associated with chemotherapy. This guideline, in which we give some treatment recommendations with level of evidence and grade of recommendation, provides an update of the previously published guideline of the Spanish Society of Medical Oncology and represents our continued commitment to improving supportive care in cancer patients.
Assuntos
Antineoplásicos/efeitos adversos , Náusea/induzido quimicamente , Náusea/prevenção & controle , Guias de Prática Clínica como Assunto , Vômito/induzido quimicamente , Vômito/prevenção & controle , Humanos , Neoplasias/tratamento farmacológico , Qualidade de Vida , EspanhaRESUMO
A mucosa estomacal é protegida por muco, constituído principalmente por prostaglandinas protetoras. O uso de anti-inflamatórios não esteroidais (AI- NEs) pode provocar gastrite devido à capacidade dos AINEs de inibir a ação da cicloxigenase resultando na não formação de prostaglandinas, tendo como sinais clínicos característicos inapetência, regurgitação ou emese, hemorragias e mele- na ou hematoquezia. Foi atendido um cão da raça Fila mestiço com 10 anos de idade, apresentando, há 10 dias, hiporexia, poliúria e polidipsia. Na anamnese, o tutor relatou que antes do aparecimento dos sinais ele forneceu ao animal fluni- xin meglumine associado à sulfa, dipirona e dimeticona, em dose desconhecida, durante 5 dias, para uma sensibilidade dolorosa nos membros posteriores; e que há cinco dias, administrou um vermífugo (pirantel, praziquantel e ivermectina). O quadro do animal piorou gradativamente e dois dias antes da consulta, o ani- mal tornou-se apático e inapetente, apresentando melena e tremores, entretanto sem a presença de emese. No exame físico, foi averiguado intensa sensibilidade abdominal, aumento dos linfonodos axilares bilaterais, ceratite no olho esquer- do, conjuntivite bilateral, mucosa hipocorada e desidratação de 10%. Imedia- tamente, foi iniciada um tratamento fluidoterápico e exames complementares, porém, o animal veio a óbito duas horas após seu internamento e assim, foi en- caminhado para a realização de necropsia, onde foi observada úlceras extensas na região caudal do esôfago e em toda a mucosa do estômago, confirmando o diagnóstico de gastrite. Diante do histórico do uso de anti-inflamatórios, somada as características das lesões e suas localizações, o diagnóstico conclusivo foi de gastrite iatrogênica por anti-inflamatório não esteroidal (AINES). Conclui-se que o uso indiscriminado de anti-inflamatórios, sem assistência de um médico veterinário, por proprietários pode provocar um quadro de gastrite iatrogênica, podendo levar a morte no caso de atraso a busca de assistência médico veteriná- ria adequada. Apesar das graves lesões apresentadas na necropsia do esôfago e estomago, o animal não apresentava vômito ou regurgitação, sinais comuns em esofagites e gastrites.