phenylephrine-hydrochloride and Vomiting

Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.. For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD.. Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN- to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/89 %).. Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.

Topics: Diagnostic Tests, Routine; Endoscopy, Digestive System; Epistaxis; Female; Gagging; Germany; Humans; Male; Middle Aged; Mouth; Nausea; Nose; Pain; Prospective Studies; Time Factors; Treatment Outcome; Vomiting

Electro-acupuncture (EA) can be effective in some pain conditions, but still there have been no randomized controlled studies of EA for treatment of acute postoperative pain in nasal septoplasty. Therefore, we did a study to test whether EA of specific points is superior to sham acupuncture for complementary analgesia after nasal septoplasty.. Ninety (90) patients with an American Society of Anesthesiology (ASA) physical status of I-II scheduled for elective septoplasty were randomly allocated to acupuncture group or control group. Postoperative pain was treated with intravenous meperidine. The time to the first analgesic request, and pain intensity on a 100-mm visual analogue scale (VAS-100) were used to evaluate postoperative pain, and the amount of postoperative meperidine and incidence of analgesia related to side-effects were recorded.. Postoperative pain intensity on VAS-100 and respiratory depression were similar in both groups (p > 0.05), but nausea and vomiting were less in the acupuncture group than in the control group (p < 0.05).. Findings from our study demonstrate that both uses of EA and 0.1 mg/kg IV morphine given intraoperatively resulted in a similar postoperative pain score, and meperidine was not given in any patient in the two groups during postoperative period because the VAS scores of all patients were less than 40 mm.

Topics: Adolescent; Adult; Analgesia; Analgesics, Opioid; Double-Blind Method; Electroacupuncture; Female; Humans; Infusions, Intravenous; Male; Meperidine; Nausea; Nose; Pain; Pain Management; Postoperative Complications; Vomiting; Young Adult

1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5. We conclude that nalbuphine (mean dose 0.13 mg kg-1) and pethidine (mean dose 1.35 mg kg-1), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Child; Double-Blind Method; Ear; Fever; Humans; Injections, Intravenous; Intraoperative Period; Middle Aged; Narcotic Antagonists; Narcotics; Nose; Pain, Postoperative; Pharynx; Postoperative Complications; Prospective Studies; Vomiting

Sixty patients were studied in a randomized, double-blind manner to determine whether metoclopramide added to droperidol decreased further the incidence of emetic symptoms (nausea, retching, vomiting) in outpatients receiving alfentanil anaesthesia for nasal surgery. Group 1 (n = 30) received metoclopramide 0.15 mg.kg-1 and Group 2 (n = 30) received placebo. In addition, both groups received droperidol 0.02 mg.kg-1 immediately before anaesthesia which was supplemented by alfentanil 20 micrograms.kg-1 at induction followed by an infusion of 0.25-1 micrograms.kg-1.min-1. Emetic symptoms were assessed 0-3 hr, 3-6 hr and 6-24 hr after surgery. Both groups received similar doses of alfentanil (mean +/- SD; Group 1 4641 +/- 1894 micrograms, Group 2 4714 +/- 1640 micrograms). The percentage of patients who had either nausea or vomiting at 0-3, 3-6 or 6-24 hr was 23%, 14% and 13% in Group 1; and 20%, 17% and 10% in Group 2. The overall incidence for each group was 8/30 (27%). There was no difference in the incidence of emetic symptoms between the groups at any time interval or throughout the study. Metoclopramide did not improve upon the antiemesis of droperidol during alfentanil anaesthesia for outpatient nasal surgery.

Topics: Adult; Alfentanil; Ambulatory Surgical Procedures; Anesthesia, Inhalation; Anesthesia, Intravenous; Double-Blind Method; Droperidol; Drug Combinations; Female; Humans; Incidence; Injections, Intravenous; Isoflurane; Male; Metoclopramide; Middle Aged; Nausea; Nitrous Oxide; Nose; Placebos; Vomiting

A controlled investigation was conducted to compare the efficacy of ketoprofen and pethidine in relief of postoperative pain after nasal surgery. Sixty patients were randomly allocated to receive intravenous ketoprofen 1.5 mg.ml-1 or pethidine 1 mg.kg-1 during induction of anaesthesia. Appearance, pain and headache were assessed 1, 2, and 4 h postoperatively, and the following morning. The use of ketoprofen was associated with a significantly faster recovery from anaesthesia (P less than 0.001), and a more rapid return to calm awakening (P less than 0.05). Patients who received ketoprofen had significantly lower pain and headache scores (P less than 0.01 and P less than 0.001, respectively), and required significantly (P less than 0.05) less postoperative analgesia. No significant difference in incidence and severity of postoperative nausea or vomiting was found between the two groups at any time. A single intravenous dose of ketoprofen during anaesthesia may offer an advantage compared to pethidine in reducing postoperative pain following nasal surgery.

Topics: Adult; Female; Headache; Humans; Infusions, Intravenous; Ketoprofen; Male; Meperidine; Nausea; Nose; Pain, Postoperative; Postoperative Complications; Vomiting

Two hundred and fourteen patients who had a cough illness lasting at least 2 weeks were studied to investigate Bordetella pertussis as a cause of prolonged cough in adolescents and adults. Medical history and nasopharyngeal swab specimens for culture and polymerase chain reaction (PCR) were obtained at presentation. Three (1·4%) patients were B. pertussis culture-positive; 15 (7%) were B. pertussis PCR-positive (including the culture-positive patients) and 11 (5·1%) were Bordetella spp. PCR-positive. Symptom combinations were significantly high both in patients with pertussis and patients with indeterminate results (P < 0·05). We conclude that B. pertussis should be considered among differential diagnoses of prolonged cough in adolescents and adults and PCR and culture should be used to detect these cases and facilitate public health response.

Topics: Adolescent; Adult; Bordetella pertussis; Child; Chronic Disease; Cough; DNA, Bacterial; Female; Humans; Male; Medical History Taking; Nose; Pharynx; Turkey; Vomiting; Whooping Cough; Young Adult

Problems related with nasal intermittent positive pressure ventilation (NIPPV) are nasal and mouth dryness, soreness on the bridge of the nose, eye irritation and epistaxis. Gastrointestinal distention due to air swallowing has been reported in half of the patients. Acceleration of digestive function with drugs or reduction of the volume delivered to alleviate gastric distension are considered as the conventional treatment. It is also possible that the problem disappears spontaneously after a few weeks of NIPPV. We present a patient in whom conventional treatment was unsuccessful. When we changed to a different ventilator, symptoms disappeared, and the new one was very well tolerated. In our experience, changing ventilators should be included in the management of gastrointestinal distension due to NIPPV, especially if conventional procedures, such as drugs or gas flow modifications, fail.

Topics: Adolescent; Aerophagy; Humans; Intermittent Positive-Pressure Ventilation; Male; Muscular Dystrophies; Nose; Respiratory Insufficiency; Vomiting

Ten breeding sows were left in direct contact with their newborn piglets that had been experimentally infected with transmissible gastroenteritis (TGE) virus. All sows became infected with the virus. The sows developed fever and showed mild clinical signs of the disease for a few days. The sows excreted virus in the nasal secretion, feces, and milk during the acute febrile phase of illness. Virus was isolated from the nasal secretion of one sow as early as 20 hours after contact exposure to the infected piglets. At necropsy, the virus was more frequently isolated from the tissues of the upper respiratory tract than from small intestines; this finding indicated that the TGE coronavirus replicated in the upper respiratory tract and induced an acute respiratory infection in susceptible adult swine. Neutralizing antibody was present in the sera 8 sows after 12 to 36 days during the convalescent period. From these results, we conclude that susceptible sows in direct contact with ill piglets can become infected and by excreting virus can serve as a source of TGE virus for other susceptible pigs on the premises.

Topics: Administration, Oral; Animals; Animals, Newborn; Diarrhea; Female; Gastroenteritis, Transmissible, of Swine; Intestine, Small; Lactation; Milk; Neutralization Tests; Nose; Pregnancy; Respiratory System; Respiratory Tract Infections; Swine; Transmissible gastroenteritis virus; Vomiting

Topics: Adult; Age Factors; Child; Ear; Female; Head; Humans; Male; Mouth; Nausea; Neck; Nose; Postoperative Complications; Sex Factors; Surgery, Plastic; Vomiting

Topics: Administration, Oral; Animals; Animals, Newborn; Brain; Encephalomyelitis; Feeding and Eating Disorders; Female; Fluorescent Antibody Technique; Hemagglutination, Viral; Humans; Infant, Newborn; Lung; Microscopy, Fluorescence; Nasal Mucosa; Nose; Orthomyxoviridae; Paramyxoviridae; Pregnancy; Pulmonary Fibrosis; Respiratory Distress Syndrome, Newborn; Swine; Swine Diseases; Trachea; Vomiting

Topics: Acids; Administration, Oral; Animals; Biological Assay; Diarrhea; Ethyl Ethers; Feces; Gastroenteritis; Guinea Pigs; Haplorhini; Hot Temperature; Human Experimentation; Humans; Immunity; Intestines; Macaca; Methods; Mice; Micropore Filters; Nose; Organ Culture Techniques; Rabbits; Species Specificity; Vomiting