Yuhji Saitoh

Comparison of ramosetron and granisetron for preventing postoperative nausea and vomiting after gynecologic surgery.

UNLABELLED In a prospective, randomized, double-blinded study, we evaluated the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting (PONV) in major gynecologic surgery. One hundred twenty patients, ASA physical status I or II, aged 23-65 yr, received i.v. granisetron 2.5 mg or ramosetron 0.3 mg (n = 60 each) at the end of surgery. A standard general anesthetic technique and postoperative analgesia were used. The incidence of a complete response, defined as no PONV and no need for another rescue medication, 0-3 h after anesthesia was 87% with granisetron and 90% with ramosetron; the corresponding incidence 3-24 h after anesthesia was 85% and 90%; the corresponding incidence 24-48 h after anesthesia was 70% and 92% (P < 0.05). No clinically serious adverse events due to the drugs were observed in any of the groups. In conclusion, prophylactic therapy with ramosetron is more effective than granisetron for the longterm prevention of PONV after major gynecologic surgery. IMPLICATIONS We compared the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting in major gynecologic surgery. Prophylactic therapy with ramosetron was more effective than granisetron for preventing postoperative nausea and vomiting 24-48 h after anesthesia.

Ramosetron for preventing postoperative nausea and vomiting in women undergoing gynecological surgery.

UNLABELLED In a prospective, randomized, double-blinded, placebo-controlled trial, we evaluated the efficacy of ramosetron at three different doses (0.15, 0.3, and 0.6 mg) for the prevention of postoperative nausea and vomiting (PONV) after gynecological surgery. One hundred twenty women, ASA physical status I or II, aged 21-63 yr, received IV either placebo or ramosetron 0.15, 0.3, or 0.6 mg (n = 30 of each) at the completion of surgery. A standard general anesthetic technique and postoperative analgesia were used. A complete response, defined as no PONV and no need for another rescue antiemetic, during 0-3 h after anesthesia occurred in 40%, 47%, 87%, and 90% of patients who had received placebo and ramosetron 0.15, 0.3, and 0.6 mg, respectively. Corresponding results during 3-24 h after anesthesia were 43%, 50%, 87%, and 90%, and 24-48 h after anesthesia were 50%, 53%, 90%, and 93% (P < 0.05). Patients who had received ramosetron 0.3 or 0.6 mg were satisfied compared with those who had received placebo (P < 0.05). There were no serious clinical adverse events caused by the study drug in any of the groups. In conclusion, ramosetron 0.3 mg is an effective antiemetic for preventing PONV during 0-48 h after anesthesia in female patients undergoing gynecological surgery. Increasing the dose to 0.6 mg provided no further benefit. IMPLICATIONS This randomized, double-blinded, placebo-controlled trial in 120 women found the effective dose of ramosetron for preventing postoperative nausea and vomiting after gynecological surgery to be 0.3 mg.

Granisetron/dexamethasone combination for reducing nausea and vomiting during and after spinal anesthesia for cesarean section.

UNLABELLED We compared the efficacy of granisetron plus dexamethasone with that of granisetron alone for preventing nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia. In a randomized, double-blinded manner, 120 patients received either granisetron 3 mg (Group I, n = 60) or granisetron 3 mg plus dexamethasone 8 mg (Group II, n = 60) IV immediately after clamping of the fetal umbilical cord. A complete response, defined as no emetic symptoms and no need for another rescue antiemetic medication in the intraoperative, postdelivery period was 83% in Group I and 98% in Group II (P = 0.008); the corresponding rates during the first 24 h after surgery was 85% and 98% (P = 0.016). No clinically serious adverse events were observed in any of the groups. In conclusion, the prophylactic use of a granisetron/dexamethasone combination is more effective than granisetron alone for reducing nausea and vomiting in patients during and after spinal anesthesia for cesarean section. IMPLICATIONS Intraoperative, postdelivery, and postoperative nausea and vomiting are distressing to patients undergoing cesarean section under spinal anesthesia. The combination of granisetron plus dexamethasone was evaluated and found to be effective for preventing these emetic symptoms.

RETRACTED ARTICLE: Ramosetronvs granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

PurposeTo compare the efficacy of ramosetron with granisetron for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.MethodsIn a randomized, double-blind study, 80 female inpatients received 3 mg granisetron or 0.3 mg ramosetroniv (n=40 of each) at the completion of surgery The standardized anesthetic included isoflurane and nitrous oxide in oxygen.ResultsComplete response, defined as no PONV during the first 24 hr (0–24 hr) after anesthesia was 85% with granisetron and 93% with ramosetron, respectively (P=0.241); the corresponding incidence during the next 24 hr (24–48 hr) after anesthesia was 63% and 90% (P=0.004). No clinically important adverse events due to the study drug were observed in any of the groups.ConclusionRamosetron was more effective than granisetron for prevention of PONV during 0–48 hr after anesthesia for laparoscopic cholecystectomy.RésuméObjectifComparer l’efficacité du ramosétron et du granisétron dans la prévention des nausées et des vomissements postopératoires (NVPO) à la suite d’une cholécystectomie laparoscopique.MéthodeL’étude randomisée, à double insu, a porté sur 80 femmes qui ont reçu 3 mg de granisétron ou 0,3 mg de ramosétroniv (n=40 dans chaque cas) après l’opération. Lanesthésie standard comprenait de l’isoflurane et un mélange de protoxyde d’azote et d’oxygène.RésultatsLa réponse complète, définie comme une absence de NVPO, a été de 85% avec le granisétron et de 93% avec le ramosétron, respectivement (P=0,241), pendant les 24 premières heures postanesthésiques (0–24 h); pendant les 24 h suivantes, l’incidence correspondante a été de 63% et de 90% (P=0,004). Aucun événement indésirable, d’importance clinique et relié aux médicaments de l’étude, n’est survenu.ConclusionLe ramosétron a été plus efficace que le granisétron à prévenir les NVPO pendant les 48 premières heures qui ont suivi la cholécystectomie laparoscopique.

RETRACTED ARTICLE: Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem

We studied the circulatory responses to laryngoscopy and tracheal intubation in 37 hypertensive patients who received nicardipine 30 μg · kg−1 iv (Group N, n = 12), diltiazem 0.3 mg · kg−1 (Group D, n = 12) or saline placebo (Group C, n = 13) 60 sec before the initiation of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg · kg−1 iv, and succinylcholine 2 mg · kg−1 iv was used to facilitate tracheal intubation after precurarization with vecuronium 0.02 mg · kg−1 iv. In patients in Group C heart rate (HR) increased from 79 ± 14 (baseline) to 110 ± 12 (P < 0.05) associated with tracheal intubation; mean arterial pressure (MAP) increased from 116 ± 8 to 140 ± 77 (P < 0.05) and rate-pressure product (RPP) increased from 13385 ± 2393 to 21251 ± 3883 (P < 0.05). The changes from baseline values in HR and RPP after tracheal intubation in Group D were less than those in Groups C and N (P < 0.05). The increase in MAP following tracheal intubation in Groups N and D was lower than that in Group C (P < 0.05). We conclude that, compared with nicardipine, administration of diltiazem iv is associated with less circulatory response to tracheal intubation in hypertensive patients.RésuméCette étude vise à déterminer, au moment de la laryngoscopie et de l’intubation trachéale, les réponses circulatoires de 37 patients hypertendus. Ces patients reçoivent de la nicardipine 30 μg · kg−1 (groupe N, n = 12), du diltiazem 0,3 mg · kg−1 (groupe D, n = 12) ou un placebo (groupe C, n = 13) 60 sec avant la laryngoscopie. L’anesthésie est induite avec du thiopentone 5 mg · kg−1 iv et la succinylcholine 2 mg · kg−1 iv est administrée pour faciliter l’intubation après précurarisation au vécuronium 0,02 mg · kg−1. Chez les patients du groupe C, la fréquence cardiaque (Fc) augmente de 79 ± 14 à 110 ± 12 (P < 0,05) au moment de l’intubation, la pression artérielle moyenne (PAM) augmente de 116 ± 8 à 140 ± 77 (P< 0,05) et le produit fréquence/pression (PFP) augmente de 13385 ± 2393 à 21251 ± 3883 (P < 0,05). Les changements de la Fc et du PFP depuis la valeur initiale après l’intubation endotrachéale étaient moindres que dans les groupes C et N (P < 0,05). L’augmentation de la PAM dans les groupes N et D était inférieure à celle du groupe C (P< 0,05). Les auteurs concluent que comparativement à la nicardipine, le diltiazem est associé chez les hypertendus à moins de répercussions circulatoires á l’intubation de la trachée.

Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis

PurposeA high incidence of postoperative nausea and vomiting (PONV) has been noted in patients with a history of postoperative emesis. This study was undertaken to compare the efficacy of granisetron, droperidol and metoclopramide, in the prevention of PONV in such patients undergoing general anaesthesia for major gynaecological surgery.MethodsIn a randomised, double-blind study, 90 female patients received 2.5 mg granisetron, 1.25 mg droperidol or 10 mg metoclopramide (n = 30 of each)iv immediately before induction of anaesthesia. The same standard general anaesthetic technique, which consisted of isoflurane in nitrous oxide and oxygen, was used. Nausea, vomiting and safety assessments were performed continuously during the first 24 hr after anaesthesia.ResultsThe incidence of PONV was 20% with granisetron, 57% with droperidol and 60% with metoclopramide (P < 0.05; overall Fisher’s exact probability test). No clinically adverse events were observed in any group.ConclusionGranisetron is more effective than droperidol or metoclopramide in preventing PONV in female patients with a history of postoperative emesis.RésuméObjectifLes patientes présentant une histoire de vomissements post opératoires ont une incidence élevée de nausées/vomissements post opératoires (NVPO). Le but de cette étude est de comparer l’efficacité du granisétron, du dropéridol et du métoclopramide en prévention des NVPO chez de tels patientes soumises à une anesthésie générale pour chirurgie gynécologique majeure.MéthodesDans une étude aléatoire et à double insu, 90 patientes ont reçu par voie I.V 2,5 mg de granisétron, 1,25 mg de dropéridol ou 10 mg de métoclopramide (n = 30 chaque groupe) immédiatement avant l’induction de l’anesthésie. La technique d’anesthésie générale consistait en isoflurane, N2O,O2 et était la même pour toutes les patientes. Lévaluation des nausée/vomissements et la surveillance ont été réalisées de façon continue durant le premier 24 heures.RésultatsL’incidence des NVPO étart de 20% avec le granisétron, 57% avec le dropéridol et 60% avec le métoclopramide (P < 0,05 test de Fisher exact). Aucun effet secondaire indésirable n’a été observé dans les trois groupes.ConclusionLe granisétron est plus efficace que le droperidol ou le métoclopramide dans la prévention des NVPO chez des patientes avec histoire de vomissements post opératoires.

Recovery of post‐tetanic count and train‐of‐four responses at the great toe and thumb

We have studied the recovery of post‐tetanic count and train‐of‐four responses at the great toe and thumb accelerographically after the administration of vecuronium 0.2 mgkg−1. Sixty adult patients scheduled for anaesthesia with nitrous oxide and isoflurane were studied. The times to the return of the first post‐tetanic twitch were comparable at the great toe and thumb (mean (SD) times: 30.0 (6.5) min and 35.0 (8.5) min, respectively). Recovery of post‐tetanic count followed similar time courses at the great toe and thumb. Also, time to the return of the first twitch of the train‐of‐four did not differ significantly at the great toe and thumb (47.5 (9.6) min vs. 49.7 (10.5) min). Similarly, time to the return of the second, third and fourth twitches of the train‐of‐four did not significantly differ at the great toe and the thumb. However, the value of the first twitch of the train‐of‐four, expressed as a proportion of control twitch, was significantly higher than that at the thumb between 50 min and 110 min after the vecuronium injection, and the train‐of‐four ratio at the great toe was significantly higher than that at the thumb between 60 min and 100 min after the vecuronium injection.

RETRACTED ARTICLE: Prophylactic antiemetic therapy with granisetron-droperidol combination in patients undergoing laparoscopic cholecystectomy

PurposeA relatively high incidence of postoperative nausea and vomiting (PONV) occurs in patients undergoing laparoscopic cholecystectomy. This study was undertaken to compare the efficacy of granisetron-droperidol combination with each drug alone for the prevention of PONV after laparoscopic cholecystectomy.MethodsIn a randomized, double-blind manner, 150 female inpatients received 3 mg granisetron (Group G), 1.25 mg droperidol (Group D) or 3 mg granisetron plus 1.25 mg droperidol (Group GD) (n = 50 for each)iv immediately before the induction of anaesthesia. The same standard general anaesthetic technique, which consisted of isoflurane and nitrous oxide in oxygen, was used. Nausea, vomiting and safety assessments were performed continuously during the first 24 hr after anaesthesia.ResultsComplete response, defined as no PONV and no administration of rescue antiemetic medication, was 86% in Group G, 64% in Group D and 98% in Group GD (P = 0.03 vs Group G,P = 0.001 vs Group D). No clinically adverse events were observed in any group.ConclusionGranisetron-droperidol combination is more effective than each antiemetic alone in the prevention of PONV after laparoscopic cholecystectomy.RésuméObjectifDes nausées et des vomissements post opératoires (NVPO) surviennent chez des patients subissant une cholécystectomie laparoscopique, selon une incidence relativement élevée. La présente étude a été entreprise pour comparer l’efficacité de la combinaison de granisétron-dropéridol et de chaque médicament employé seul afin de prévenir les NVPO à la suite d’une cholécystectomie laparoscopique.MéthodesDans une étude randomisée, en double insu, 150 patientes ont reçu 3 mg de granisétron (Groupe G), 1,25 mg de dropéridol (Groupe D) ou 3 mg de granisétron plus 1,25 mg de dropéridol IV (Groupe GD) (n = 50 pour chacun) immédiatement avant l’induction de l’anesthésie. On a utilisé pour toutes les patientes la même technique traditionnelle d’anesthésie générale qui comprend l’emploi de l’isoflurane et de protoxyde d’azote dans l’oxygène. L’évaluation des nausées, des vomissements et des effets secondaires a été réalisée de façon continue pendant les 24 premières heures suivant l’anesthésie.RésultatsLa réponse complète, définie comme l’absence de NVPO et d’administration d’antiémétique correctif, était de 86 % dans le Groupe G, 64 % dans le Groupe D et de 98 % dans le groupe GD (P = 0,03 vs Groupe G,P = 0,001 vs Groupe D). Aucune réaction clinique défavorable n’a été observée dans les groupes.ConclusionLa combinaison de granisétron-dropéridol est plus efficace que chaque antiémétique employé seul dans la prévention des NVPO après une cholécystectomie laparoscopique.

Effective dose of granisetron for the prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

This study was undertaken to determine the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of post-operative nausea and vomiting (PONV) in female patients undergoing elective laparoscopic cholecystectomy. In randomized, placebo-controlled, double-blind study, 120 women were assigned to receive either placebo (saline) or granisetron at three different doses (20 micrograms kg-1, 40 micrograms kg-1 or 80 micrograms kg-1) intravenously immediately before the induction of anaesthesia. All patients received standardized anaesthesia consisting of isoflurane and nitrous oxide in oxygen. The incidence of PONV during the first 24 hours after anaesthesia was 43, 40, 13 and 13% after administration of placebo and granisetron 20 micrograms kg-1, 40 micrograms kg-1 and 80 micrograms kg-1, respectively (P < 0.05, overall Fishers exact probability test). Adverse effects post-operatively were not different among the groups. In conclusion, granisetron 40 micrograms kg-1 is the minimum effective dose in the prevention of PONV after laparoscopic cholecystectomy.

Prevention of Vomiting After Tonsillectomy in Children: Granisetron Versus Ramosetron

Objective/Hypothesis Granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting after tonsillectomy in children. Ramosetron (Nasea; Yamanouchi; Tokyo, Japan), another new antagonist of 5‐hydroxytryptamione type 3 receptor, has more potent and longer‐acting properties than granisetron (Kytril; Smith Kline Beecham, London, UK) against cisplatin‐induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting after pediatric tonsillectomy.