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Concept: Metoclopramide


Roughly one in three individuals is highly susceptible to motion sickness and yet the underlying causes of this condition are not well understood. Despite high heritability, no associated genetic factors have been discovered. Here, we conducted the first genome-wide association study on motion sickness in 80,494 individuals from the 23andMe database who were surveyed about car sickness. Thirty-five single-nucleotide polymorphisms (SNPs) were associated with motion sickness at a genome-wide-significant level (p<5×10-8). Many of these SNPs are near genes involved in balance, and eye, ear, and cranial development (e.g., PVRL3, TSHZ1, MUTED, HOXB3, HOXD3). Other SNPs may affect motion sickness through nearby genes with roles in the nervous system, glucose homeostasis, or hypoxia. We show that several of these SNPs display sex-specific effects, with up to three times stronger effects in women. We searched for comorbid phenotypes with motion sickness, confirming associations with known comorbidities including migraines, postoperative nausea and vomiting (PONV), vertigo, and morning sickness, and observing new associations with altitude sickness and many gastrointestinal conditions. We also show that two of these related phenotypes (PONV and migraines) share underlying genetic factors with motion sickness. These results point to the importance of the nervous system in motion sickness and suggest a role for glucose levels in motion-induced nausea and vomiting, a finding that may provide insight into other nausea-related phenotypes like PONV. They also highlight personal characteristics (e.g., being a poor sleeper) that correlate with motion sickness, findings that could help identify risk factors or treatments.

Concepts: Central nervous system, DNA, Genetics, Bioinformatics, Vomiting, Nausea, Metoclopramide, Postoperative nausea and vomiting


A novel treatment, chewing gum, may be non-inferior to ondansetron in inhibiting postoperative nausea and vomiting (PONV) in female patients after laparoscopic or breast surgery. In this pilot study, we tested the feasibility of a large randomized controlled trial.

Concepts: Randomized controlled trial, Surgery, Chemotherapy, Anesthesia, Vomiting, Nausea, Metoclopramide, Postoperative nausea and vomiting


BACKGROUND: Open thyroidectomy is associated with a high incidence of postoperative nausea and vomiting (PONV) in up to 70 % of cases. Use of the recently introduced robot-assisted endoscopic thyroidectomy using a gasless transaxillary approach has been increasing because of its several advantages over open thyroidectomy. This study compared the incidence of PONV in the women who underwent open or robot-assisted thyroidectomy. METHODS: This prospective, double-blinded study enrolled 170 women 20-60 years of age who were scheduled for conventional open thyroidectomy (group O) or robot-assisted thyroidectomy (group R). A standard anesthetic technique, including sevoflurane and air in oxygen, was used. During a 0-24-h postoperative period, the presence and severity of PONV (nausea, retching/vomiting), severity of pain, need for rescue antiemetics, and the degree of patient satisfaction were evaluated. RESULTS: During the 0-6-h postoperative period, the incidence of PONV and mean pain score (40.0 vs. 51.8 %and 4.2 vs. 4.8 in groups R and O, respectively) were not significantly different. At 6-24 h postoperatively, the incidence of PONV (18.8 vs. 44.7 %), severe emesis (11.8 vs. 29.4 %) and mean pain score (2.8 vs. 3.8) were significantly lower in group R compared to group O, respectively. Overall, the incidence of PONV (42.4 vs. 63.5 %) and severe emesis (20.0 vs. 43.5 %) were significantly lower in group R compared to group O, respectively. The incidence of satisfied patients 6 and 24 h after the end of anesthesia (55.3 vs. 28.2 and 82.4 vs. 58.8 %) were significantly higher in group R compared to group O, respectively. CONCLUSIONS: Robotic thyroidectomy reduces the incidence and severity of PONV compared to open thyroidectomy during a 0-24-h postoperative period.

Concepts: Chemotherapy, Anesthesia, Opioid, Vomiting, Nausea, Metoclopramide, Postoperative nausea and vomiting, Hypnosurgery


Case The objective of this case report is to report the development of tardive dyskinesia in an African-American adolescent male after short-term treatment with metoclopramide 10 mg orally three times daily secondary to delayed gastric emptying. The patient developed symptoms of tardive dyskinesia after 2 days of therapy with metoclopramide. Metoclopramide was discontinued and diphenhydramine 50 mg was initially administered intravenously followed with 25 mg orally every 4 hours as needed. While there are case reports of drug-induced tardive dyskinesia after intravenous administration of metoclopramide, this is to our knowledge the first report of tardive dyskinesia after short-term treatment with oral metoclopramide in an adolescent. Conclusion Awareness of the risk of development of this adverse effect even with short-term treatment with metoclopramide and in younger patients is important.

Concepts: Medical terms, Patient, Intravenous therapy, Report, Tardive dyskinesia, Bolus, Metoclopramide, Case report


INTRODUCTION: Our objective was to evaluate the contribution of bilateral inferior alveolar nerve block (BIANB) in patients before mandibular sagittal osteotomy for postoperative pain management, consumption of opioids, treatment of nausea and vomiting. MATERIALS AND METHODS: We included 30 patients undergoing mandibular sagittal osteotomy in a prospective, randomized, double blind study. The first group of patients (n=14) underwent a standard procedure (general anesthesia with postoperative morphine treatment). The second group of patients (n=16) underwent BIANB before surgery, in addition to the standard procedure. The postsurgical management was evaluated every four hours for the first 24hours, according to the following criteria: postoperative nausea and vomiting (PONV), visual analogue scale (VAS) assessment of pain, consumption of morphine (cumulative dose) and antiemetic drugs, and need for releasing inter-maxillary blockage. RESULTS: PONV was significantly less frequent in the second group (6.3 % versus 42.9 %, P=0.031). The frequency of releasing inter-maxillary blockage and the consumption of antiemetic drugs were not significantly different in the two groups. The mean VAS pain score was significantly lower in the second group (1.6 versus 0.9 avec P=0.045). There was no significant difference in cumulative morphine requirements between the two groups at 24hours. DISCUSSION: BIANB during mandibular osteotomy increases the patient comfort by decreasing PONV and improving postsurgical analgesia.

Concepts: Pharmacology, Anesthesia, Opioid, Analgesic, Vomiting, Metoclopramide, Postoperative nausea and vomiting, Blind experiment


Emergency Department (ED) headache patients are commonly treated with neuroleptic antiemetics like metoclopramide. Haloperidol has been shown to be effective for migraine treatment.

Concepts: Hospital, Randomized controlled trial, Migraine, Tardive dyskinesia, Haloperidol, Antiemetic, Chlorpromazine, Metoclopramide


We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p = 0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p = 0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p = 0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p = 0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p = 0.53, and 0.87 (0.65-1.17), p = 0.36 respectively.

Concepts: Cohort study, Medical statistics, Randomized controlled trial, Chemotherapy, Anesthesia, Vomiting, Metoclopramide, Postoperative nausea and vomiting


Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients, but these agents may be harmful. We conducted a systematic review on the comparative safety of 5-HT3 receptor antagonists.

Concepts: Chemotherapy, Receptor antagonist, Serotonin, 5-HT3 antagonist, Ondansetron, Ligand-gated ion channel, Metoclopramide, 5-HT3 receptor


With little scientific evidence to support use of aromatherapy for postoperative nausea and/or vomiting (PONV) symptoms, this study evaluated controlled breathing with peppermint aromatherapy (AR) and controllled breathing alone (CB) for PONV relief.

Concepts: Disease, Randomized controlled trial, Symptoms, Symptom, Vomiting, Metoclopramide, Postoperative nausea and vomiting


Although serotonin (5-HT3) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy.

Concepts: Chemotherapy, Serotonin, 5-HT3 antagonist, Ondansetron, Antiemetic, 5-HT receptor, Metoclopramide, 5-HT3 receptor