Article

Transdermal scopolamine for prevention of intrathecal morphine-induced nausea and vomiting after cesarean delivery

Harvard University, Cambridge, Massachusetts, United States
Anesthesia and analgesia (Impact Factor: 3.42). 10/2007; 105(3):764-9. DOI: 10.1213/01.ane.0000277494.30502.db
Source: PubMed

ABSTRACT Intrathecal morphine for cesarean delivery provides excellent postoperative analgesia but is associated with significant nausea and vomiting.
We compared the antiemetic efficacy of transdermal scopolamine, IV ondansetron, and placebo during the first 24 h postoperatively. Two-hundred forty women undergoing cesarean delivery under spinal anesthesia were randomly allocated, in a double-blind study design, to receive transdermal scopolamine 1.5 mg, ondansetron 4 mg, or placebo at the time of cord clamping.
Our study showed that the overall rates for all emesis were 59.3% in the placebo group and were reduced to 40% in the scopolamine group and 41.8% in the ondansetron group. The greatest reduction in emesis in the scopolamine group when compared with placebo was in the 6-24 h time period.
Scopolamine is an effective medication for prophylactic use in parturients receiving intrathecal morphine while undergoing cesarean delivery. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.

Full-text

Available from: Scott Segal, Jun 07, 2015
0 Followers
 · 
156 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to systematically review the available literature on the clinical implications of medication-induced salivary gland dysfunction (MISGD). The systematic review was performed using PubMed, Embase, and Web of Science (through June 2013). Studies were assessed for degree of relevance and strength of evidence, based on whether clinical implications of MISGD were the primary study outcomes, as well as on the appropriateness of study design and sample size. For most purported xerogenic medications, xerostomia was the most frequent adverse effect. In the majority of the 129 reviewed papers, it was not documented whether xerostomia was accompanied by decreased salivary flow. Incidence and prevalence of medication-induced xerostomia varied widely and was often associated with number and dose of medications. Xerostomia was most frequently reported to be mild-to-moderate in severity. Its onset occurred usually in the first weeks of treatment. There was selected evidence that medication-induced xerostomia occurs more frequently in women and older adults and that MISGD may be associated with other clinical implications, such as caries or oral mucosal alterations. The systematic review showed that MISGD constitutes a significant burden in many patients and may be associated with important negative implications for oral health. Copyright © 2015 Elsevier Inc. All rights reserved.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 03/2015; DOI:10.1016/j.oooo.2014.10.027 · 1.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70-80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. The guidelines restrict the use of dexamethasone, transdermal scopolamine, aprepitant, and palonosetron as rescue medication 6 h after surgery. In an effort to find a safer and reliable therapy for PONV, new drugs with antiemetic properties and minimal side effects are needed, and scopolamine may be considered an effective alternative. Scopolamine is a belladonna alkaloid, α-(hydroxymethyl) benzene acetic acid 9-methyl-3-oxa-9-azatricyclo non-7-yl ester, acting as a non-selective muscarinic antagonist and producing both peripheral antimuscarinic and central sedative, antiemetic, and amnestic effects. The empirical formula is C17H21NO4 and its structural formula is a tertiary amine L-(2)-scopolamine (tropic acid ester with scopine; MW = 303.4). Scopolamine became the first drug commercially available as a transdermal therapeutic system used for extended continuous drug delivery during 72 h. Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects.
    Frontiers in Pharmacology 04/2014; 5:55. DOI:10.3389/fphar.2014.00055
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We have quantitatively assessed the effectiveness of nanoshells to enhance the quality of optical coherence tomography images. Depending on concentration, nanoshells increased image signal intensities by up to 13 decibels.
    Proceedings of SPIE - The International Society for Optical Engineering 06/2005; DOI:10.1109/CLEO.2005.202364 · 0.20 Impact Factor