Prophylactic ondansetron for post-operative emesis: meta-analysis of its effectiveness in patients with and without a previous history of motion sickness.

The post-operative anti-emetic efficacy of 4 and 8 mg of ondansetron in adult patients with and without a previous history of motion sickness (PHMS) was assessed by meta-analysis. MEDLINE and EMBASE databases were searched for randomized placebo-controlled trials evaluating the anti-emetic effectiveness of ondansetron in a 24-h period. In the 49 studies found, a further selection was with respect to those studies that noted the patient's previous history of motion sickness. Twelve trials involving 2122 patients; 446 previous history of motion sickness(+) patients and 1676 previous history of motion sickness(-) patients met the selection criteria. The dose of 4 mg ondansetron was 71.5% more effective in previous history of motion sickness(+) than in previous history of motion sickness(-) patients. For the 8 mg dose, the odds ratios (95% CI) were: previous history of motion sickness(+) = 3.11 (1.40-6.93) and previous history of motion sickness(-) = 2.08 (1.35-3.21). The calculated number needed to treat was also more favourable in previous history of motion sickness(+) patients for both doses of ondansetron, demonstrating a higher effectiveness in this subgroup of patients.     

Vestibular and postural findings in the motion sickness syndrome

The motion sickness syndrome constitutes varying degrees of subjective motion intolerance and three objective findings: hyperactive VOR (79%), hip sway strategy (60%), and positional nystagmus (42%). It is present in subjects who have a strong history of motion sickness. Vestibular rehabilitation appears to help control symptoms. The study also suggests an inheritance pattern, but a structured pedigree could not be constructed. Prospective studies are warranted to further establish the patterns of the motion sickness syndrome.     

Dexamethasone prevents postoperative nausea and vomiting more effectively in women with motion sickness

PURPOSE: To evaluate the antiemetic effect of iv dexamethasone for preventing postoperative nausea and vomiting (PONV) in women with and without a history of motion sickness. METHODS: This randomized, double-blinded, placebo-controlled study was carried out in 168 female patients with (n = 84) and without (n = 84) a history of motion sickness undergoing gynecological laparoscopy. Patients received 8 mg dexamethasone or saline immediately before induction of anesthesia. Postoperatively patients were assessed for 24 hr for nausea, vomiting, and complete response (no vomiting, no need for rescue antiemetics). RESULTS: The complete response for patients with a history of motion sickness was 80.5% and 37.5% for recipients of dexamethasone and saline, respectively [P < 0.001; number needed-to-treat (NNT) = 2.3]; with corresponding incidences of 83.3% and 53.7% when there was no such history (P = 0.009; NNT = 3.4). Calculation of the efficacy of dexamethasone for the different subgroups shows that dexamethasone was 45.3% more effective in patients with motion sickness than in those without it. CONCLUSIONS: Prophylactic administration of dexamethasone is effective in reducing PONV in patients with and without a history of motion sickness. The results of this study were more favourable in patients with a history of motion sickness, demonstrating a higher effectiveness of dexamethasone for preventing PONV in this subgroup of patients.     

LOGISTIC REGRESSION ANALYSIS OF FIXED PATIENT FACTORS FOR POSTOPERATIVE SICKNESS: A MODEL FOR RISK ASSESSMENT

One hundred and forty-seven patients undergoing minor orthopaedicsurgery were studied prospec-tively by logistic regression analysisto determine the association of independent fixed patient factorswith the incidence of postoperative sickness (nausea, retchingor vomiting). Gender, history of previous postoperative sicknness,postoperative opioids and interaction between gender and previoushistory of sickness were significant independent factors forpostoperative sickness; history of motion sickness was weaklyassociated. The probability of postoperative sickness in thefirst 24 h after surgery may be estimated from the equation:log it postoperative sickness = –5.03+2.24(postoperativeopioids) + 3.97 (previous sickness history) + 2.4(gender) +0.78 (motion sickness)—3.2(gender x previous sicknesshistory). (Log likelihood ratio test for 5 degrees of freedomfor the coefficients, chi-square = 53.5 (P < 0.001).) Itis suggested that the calculated probability for sickness maybe a useful addition for balancing patient treatment groupsand allowing between-study comparisons. (Br. J. Anaesth. 1993;70:135–140)     

P6 acupressure increases tolerance to nauseogenic motion stimulation in women at high risk for PONV

PURPOSE: In a previous study we noticed that P6 acupressure decreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acu-pressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure. METHODS: 60 women with high and low susceptibilities for motion sickness participated in a randomized and double-blind study with an active P6 acupressure, placebo acupressure, and a control group (n = 20 in each group). The risk score for PONV was over 50%. The motion challenge was by eccentric rotation in a chair, blindfolded and with chin to chest movements of the head. The challenge was stopped when women reported moderate nausea. Symptoms were recorded. RESULTS: Mean time to moderate nausea was longer in the P6 acu-pressure group compared to the control group. P6 acupressure = 352 (259-445), mean (95% confidence interval) in seconds, control = 151 (121-181) and placebo acupressure = 280 (161-340); (P = 0.006). No difference was found between P6 and placebo acupressure or placebo acupressure and control groups. Previous severity of motion sickness did not influence time to nausea (P = 0.107). The cumulative number of symptoms differed between the three groups (P < 0.05). Fewer symptoms were reported in the P6 acupressure compared to the control group P < 0.009. Overall, P6 acupressure was only marginally more effective than placebo acupressure on the forearms. CONCLUSION: In females with a history of motion sickness P6 acu-pressure increased tolerance to experimental nauseogenic stimuli, and reduced the total number of symptoms reported.     

Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness

A history of motion sickness is one of the patient-related factors associated with postoperative emesis. This prospective, randomized, double-blind, placebo-controlled study was undertaken to assess the efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for preventing postoperative vomiting after tonsillectomy in 120 children with (n = 60) and without (n = 60) a history of motion sickness. Patients received a single dose of granisetron (40 micrograms.kg-1) or placebo (saline) (n = 30 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue medication, during the first 24 h after anaesthesia was 77% and 13% in patients with a history of motion sickness who had received granisetron or placebo, respectively; the corresponding incidence was 83% and 40% in those without it (P < 0.05; chi 2 test with Yates' continuity correction). No clinically serious adverse effects due to the study drug were observed in any of the groups. In conclusion, prophylactic antiemetic therapy with granisetron is effective for preventing postoperative emesis in children with a history of motion sickness as well as in those without it.     

Influence of a new discrete‐time LQR‐based motion cueing on driving simulator

This study proposes a method and an experimental validation to analyze dynamics response of the simulator's cabin and platform with respect to the type of the control used in the hexapod driving simulator. In this article, two different forms of motion platform tracking control are performed as a classical motion cueing algorithm and a discrete‐time linear quadratic regulator (LQR) motion cueing algorithm. For each situation, vehicle dynamics and motion platform level data are registered from the driving simulation software. In addition, the natural frequencies of the roll accelerations are obtained in real‐time by using FFT. The data are denoised by using wavelet 1D transformation. The results show that by using discrete‐time LQR algorithm, the roll acceleration amplitudes that correspond to the natural frequencies and the total roll jerk have decreased at the motion platform level. Also, the natural frequencies have increased reasonably by using the discrete LQR motion cueing (1.5–2.2 Hz) compared with using the classical algorithm (0.4–1.5 Hz) at the motion platform, which is an indicator of motion sickness incidence avoidance. The literature shows that lateral motion (roll, yaw, etc.) in the frequency range of 0.1–0.5 Hz induces motion sickness. Furthermore, using discrete‐time LQR motion cueing algorithm has decreased the sensation error (motion platform–vehicle (cabin) levels) two times in terms of total roll jerk. In conclusion, discrete‐time LQR motion cueing has reduced the simulator sickness more than the classical motion cueing algorithm depending on sensory cue conflict theory. Copyright © 2013 John Wiley & Sons, Ltd.     

Epidemiology of distal radius fracture in Stockholm 1981–82

Background Theoretically, the motion of a bipolar hip prosthesis is most likely to occur at the inner joint if the frictional coefficients are equal at both surfaces. However, many studies have suggested that most motion occurs at the outer joint. Material and methods We performed an analysis of motion in a cadaveric bone model and in 50 patients during fluoroscopic examination, to determine how the motion is distributed between the two joints and what factors contribute to this distribution. Results The motion distributions varied widely between the patients. However, there was a relative preponderance (63–90%) of outer motion in all directions of leg movement in addition to a persistent coexistence of motion at both joints in 44 of 50 patients. This preponderance of outer motion was the result of an early impingement of the acetabular cup and structural differences between the two joints. Interpretation An adjustment of the positive eccentricity and a decrease in the frictional torque of the inner joint as a result of better lubrication and smoothness can be expected to improve the motion distribution, thus reducing the amount of acetabular erosion.     

Evaluation of motion sickness susceptibility by motion sickness susceptibility questionnaire in adolescents with idiopathic scoliosis: a case–control study

Purpose

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, with unknown origin. Some studies have noted impaired postural balance in AIS, in particular, difficulty to manage situations with sensory conflict. The motion sickness susceptibility can be secondary to a sensory conflict, for example, between visual and vestibular information. Our hypothesis is: patients with AIS have difficulty in managing situations with sensory conflict and therefore have increased motion sickness susceptibility. The purpose of this study was to evaluate in AIS subjects by evaluating their susceptibility to motion sickness, as compared to a control group.

Methods

We conducted an analysis of data on motion sickness susceptibility collected prospectively from 2012, with the B score of motion sickness susceptibility questionnaire. This evaluation was completed for 65 adolescents (age 14.5 ± 1.6 year) with major right thoracic AIS (Cobb = 40.7° ± 13.1°) and 71 matched controls (14.6 ± 1.6 year).

Results

Adolescents with major right thoracic AIS were more susceptible to motion sickness (B score = 5.3 ± 5.8) than controls (B score = 3.4 ± 3.7) with significant difference (p = 0.025).

Conclusions

We interpret our results suggesting there is difficulty for patients with AIS to manage situations with sensory conflict. Previous studies focusing on situations with sensory conflict in AIS have required sophisticated technology. They are not accessible for routine patient management. Our research shows the same result with simple, non invasive, low-cost and quick method: B score of motion sickness susceptibility questionnaire.

     

Reduction of motion sickness in prehospital trauma care

Motion sickness adds to the discomfort of many patients being transported by ambulance. Recent research has demonstrated the effectiveness of oxygen therapy in reducing motion sickness during transport to hospital. However, patients reported negative reactions to wearing a facemask, which produced feelings of claustrophobia and anxiety. We therefore tested the hypothesis that supplemental oxygen inhaled from a new oxygen delivery device OxyArm, which avoids direct contact with the patient's skin, may reduce the incidence of motion sickness and increase patient satisfaction. Forty patients suffering from minor trauma were included in a prospective, randomised trial. Twenty patients received oxygen administered using a conventional Venturi mask (group 1), and 20 patients received oxygen using the new OxyArm device (group 2). Measurements made included oxygen saturation (SaO2), heart rate, systolic and diastolic blood pressures, and patients' subjective score of satisfaction with smell of the device, claustrophobia, inconvenience produced by the oxygen inhalation device and nausea were scored using a visual analogue scale. All patients were haemodynamically stable and comparable between the two groups. Peripheral SaO2 increased in both groups. The scores of nausea and claustrophobia were significantly lower in the OxyArm group, in addition, satisfaction with the OxyArm device was significantly higher. In conclusion, the use of OxyArm device produced a lower incidence of motion sickness combined with the additional benefit of greater patient satisfaction, when compared with a conventional facemask, during prehospital transfer of trauma patients.     

Comparison of granisetron, droperidol, and metoclopramide for prevention of postoperative vomiting in children with a history of motion sickness undergoing tonsillectomy

BACKGROUND/PURPOSE: A history of motion sickness is one of the patient-related factors associated with postoperative vomiting (POV). This study was undertaken to compare the efficacy of granisetron, droperidol, and metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness. METHODS: In a prospective, randomized, double-blinded trial, 90 pediatric patients, aged 4 to 10 years, received granisetron, 40 microg/kg; droperidol, 50 microg/kg; or metoclopramide, 0.25 mg/kg (n = 30 of each) intravenously after an inhalation induction of anesthesia. Emetic episodes and safety assessments were performed during the first 24 hours after anesthesia. RESULTS: Twenty-two of 30 patients (73%) who had received granisetron were emesis free during the first 24 hours after surgery as compared with 7 of 30 (23%) who had received droperidol (P <.05) or 6 of 30 (20%) who had received metoclopramide (P <.05). No clinically serious adverse events were observed in any of the groups. CONCLUSION: Prophylactic therapy with granisetron is superior to droperidol or metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness.     

RETRACTED ARTICLE: Antiemetic effects of granisetron on postoperative nausea and vomiting in patients with and without motion sickness

Purpose

This randomized, placebo-controlled, double-blind study was to evaluate the effects of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for preventing postoperative nausea and vomiting in 110 patients with (n = 50) and without (n = 60) a history of motion sickness undergoing general anaesthesia for major gynaecological surgery.

Methods

The patients received a single dose of either granisetron (40 μg · kg^?1) or placebo (saline) iv over 2–5 min immediately before induction of anaesthesia. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of nausea and vomiting were recorded.

Results

Except for a positive history of motion sickness, the treatment groups were similar for patient characteristics, types of surgery, anaesthetics administered and opioids given. Postoperatively, the frequency of nausea was 44% and 16% after administration of placebo and granisetron in patients with motion sickness, and was 30% and 7% in patients without it, respectively; the corresponding frequencies of vomiting were 28%, 8%, 13% and 3%. The incidence of adverse events postoperatively were not different among the groups.

Conclusion

These results suggest that preoperative prophylactic administration of granisetron is effective and safe for preventing postoperative nausea and vomiting in patients with motion sickness as well as in patients without it.     

Subjective concomitants of motion sickness: quantifying rotation-induced illness in squirrel monkeys

It has been suggested by numerous researchers that the development of conditioned food aversion (CFA) in experimental animals represents the presence of a subjective state of illness. Squirrel monkeys with proven susceptibility to rotation-induced vomiting were given surgical bilateral labyrinthectomies, a procedure known to abolish signs and symptoms of motion sickness in human beings. Postoperatively, labyrinthectomized monkeys neither vomited nor revealed any reduction in food consumption when exposed to provocative rotation. Other samples of monkeys known to be refractory to horizontal rotation and to sinusoidal vertical motion also exhibited little tendency to acquire a conditioned aversion to banana. But monkeys who had sham operations and those who revealed weak-to-strong signs of motion sickness exhibited a marked CFA (significant reduction in food intake). The strength of CFA was much greater when elicited in the test vehicle when compared with response in the home cage. The findings are interpreted as support for a limited application of CFA procedures for inferring the presence of motion-induced nausea and malaise.     

Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia

The efficacy of ondansetron 4 mg and 8 mg was compared with placebo in the reduction of postoperative nausea, retching and vomiting (PONV) after middle ear surgery during general anaesthesia, in 75 patients, in a double-blind and randomized study. Both doses of ondansetron were predictors for a decrease in PONV and the number of doses of rescue antiemetic needed per patient (droperidol: from 0.72 in the placebo group to 0.32 in both the 4-mg and 8-mg groups). No reduction in PONV was observed in patients with a history of motion sickness, whereas in patients without a history of motion sickness, ondansetron reduced both the proportion of patients suffering from PONV from 53% to 20% (P < 0.05) and of those needing droperidol from 53% to 17% (P < 0.05).      

Why does outer joint motion predominate in bipolar hip prosthesis? Experimental and clinical studies

BACKGROUND: Theoretically, the motion of a bipolar hip prosthesis is most likely to occur at the inner joint if the frictional coefficients are equal at both surfaces. However, many studies have suggested that most motion occurs at the outer joint. MATERIAL AND METHODS: We performed an analysis of motion in a cadaveric bone model and in 50 patients during fluoroscopic examination, to determine how the motion is distributed between the two joints and what factors contribute to this distribution. RESULTS: The motion distributions varied widely between the patients. However, there was a relative pre-ponderance (63-90%) of outer motion in all directions of leg movement in addition to a persistent coexistence of motion at both joints in 44 of 50 patients. This preponderance of outer motion was the result of an early impingement of the acetabular cup and structural differences between the two joints. INTERPRETATION: An adjustment of the positive eccentricity and a decrease in the frictional torque of the inner joint as a result of better lubrication and smoothness can be expected to improve the motion distribution, thus reducing the amount of acetabular erosion.     

Effect of transdermal hyoscine on nausea and vomiting during and after middle ear surgery under local anaesthesia

The efficacy of transdermal hyoscine in the reduction of nausea, retching and vomiting was compared with placebo during and after stapedo- and tympanoplasty under local anaesthesia in a double-blind, prospective and randomized study. In the placebo group (n = 29), 69% of the patients were free from emetic symptoms during and 41% after the operation. The corresponding figures were 93% (P < 0.05) and 74% (P < 0.05) in the hyoscine group (n = 27). The patients in the placebo group needed more droperidol during and after operation (P < 0.05). The frequency of side effects was similar in both groups. In posturography the patients with emetic sequelae in the placebo group had a markedly deteriorated upkeep of posture (P < 0.05) measured as body sway velocities. A strong correlation was found between motion sickness and emetic sequelae after surgery, and patients with a history of motion sickness benefited most from hyoscine.      

Motion sickness and postoperative vomiting in children

BACKGROUND: Motion sickness is considered an important risk factor for postoperative nausea and vomiting in children. The aim of this study was to verify the impact of motion sickness on the incidence of vomiting after routine surgery in children, and to compare the incidence of vomiting, after combined regional/general anaesthesia, using either halothane or sevoflurane. METHODS: We prospectively studied 420 children (369 males and 51 females) who received general anaesthesia and inguinal field block for common paediatric surgery. The children were randomly allocated into one of two groups (halothane or sevoflurane). In the 200 children in the first group (H), general anaesthesia was induced and maintained with halothane, whereas in the 220 children in the second group (S), anaesthesia was induced and maintained with sevoflurane. RESULTS: There were 79 children with a prior history of motion sickness (MS+) and 341 without such a history (MS-). In the MS+ population, the incidence of vomiting was similar in both H and S groups, being around 33%. However, repeated episodes of vomiting in MS+ children were more frequent when halothane was used. In the MS- group, the incidence of vomiting was significantly greater in the H group (19%) than in the S group (8%). CONCLUSIONS: In the postoperative period, we found that MS+ children vomit more than MS- children, regardless of the inhalation anaesthetic used. However, MS- children displayed a higher incidence of vomiting when halothane was used rather than sevoflurane.     

RETRACTED ARTICLE: Prevention of PONV with granisetron, droperidol and metoclopramide in female patients with history of motion sickness

Purpose

Motion sickness is one of the patient-related factors associated with postoperative nausea and vomiting (PONV). This study was undertaken to assess the efficacy of granisetron, droperidol and metoclopramide for preventing PONV in female patients with a history of motion sickness undergoing major gynaecological surgery.

Methods

In a prospective, randomized, placebo-controlled, double-blind study. 120 patients received either 1.25 mg dropendol. 10 mg metoclopramide, 40 μkg granisetron or placebo (saline)iv immediately before induction of anaesthesia. A standardized anaesthetic technique and postoperative analgesia were used in all patients. During the first 24 hr after anaesthesia, the incidence of PONV and adverse events were recorded by nursing-staff.

Results

The treatment groups were similar for patient demographics, types of surgery, anaesthetics administered and opioid given. The incidence of PONV was 70%, 50%. 57% and 23% in the placebo, droperidol, metoclopramide and granisetron groups, respectively (P < 0.05; overall χ² test). No difference in the incidence of adverse events was observed in either group.

Conclusion

Granisetron is a better prophylactic antiemetic than dropendol or metoclopramide in female patients with a history of motion sickness undergoing major gynaecological surgery.     

Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting?

Preoperative anxiety has been suggested as a predictor of postoperative nausea and vomiting (PONV), but supporting data are lacking. We quantified the added predictive value of preoperative anxiety to established predictors of PONV in 1389 surgical inpatients undergoing various procedures, by using multivariate logistic regression analysis. Investigated predictors were a history of PONV or motion sickness, smoking, sex, age, ethnicity, body mass index, ASA physical status, surgery type, duration of anesthesia, anesthetic technique, and postoperative opioid analgesia. Anxiety was measured by the Spielberger State-Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. The outcome was the occurrence of PONV in the first 24 h after surgery. The area under the receiver operating characteristic curve of a multivariate (logistic regression) model including sex, age, smoking, history of PONV or motion sickness, surgery type, and anesthetic technique was 0.72 (95% confidence interval, 0.70-0.74). There was a weak but significant association of anxiety with PONV, but the addition of anxiety to the model did not further increase the area under the receiver operating characteristic curve. Therefore, routine preoperative measurement of anxiety does not seem warranted, provided that the other predictors are already considered.     

全麻病人术后恶心呕吐的危险因素及预模型的构建

目的 筛选全麻病人术后恶心呕吐(PONV)的危险因素,并构建预测模型.方法 选择本院2008年8月至2008年9月全麻下行口腔、耳鼻喉、食管、肺部、骨科、普通外科、妇科手术的病人,年龄＞15岁、ASA Ⅰ～Ⅲ级,收集病人和手术等有关因素,记录术后24 h内恶心呕吐的发生情况.采用Logistic回归分析的方法筛选PONV的危险因素.根据Logistic回归分析得出的危险因素数量和危险因素及其相关系数(多元回归)分别构建两种PONV预测模型,绘制ROC曲线,计算曲线下面积(AUC)以评估预测模型的效能.结果 共纳入350例全麻病人,术后恶心和呕吐的发生率分别为36.6%和22.3%.Logistic回归分析结果显示,女性、PONV史、晕动史、偏头痛史和妇科或腹腔镜手术是PONV的独立危险因素.以危险因素数量建立的预测模型的AUC为0.749±0.027,多元回归预测模型的AUC为0.755±0.027.结论 女性、PONV史、晕动史、偏头痛史、妇科手术或腹腔镜手术是全麻病人PONV的危险因素,根据危险因素的数量可初步筛选PONV高危人群.