臺灣博碩士論文加值系統

嘔吐是一個令人非常難過的經驗，在病人接受麻醉手術後、化學治療和止痛控制用藥時，皆常產生嘔吐。而目前所使用的止吐藥不是藥價太貴就是有明顯的副作用，所以尋求一個副作用較少的有效止吐劑，便成為現今臨床醫學逼切的課題。自從1981年始，即有學者報告使用dexamethasone可以有效的預防治療癌症所引發之嘔吐，自此以後續有眾多文獻發表，支持dexamethasone在癌症治療之止吐效果。使用dexamethasone單一低劑量無副作用且價格便宜。有關dexamethasone在預防手術後嘔吐的報告並不多，其止吐機制也並不清楚，因此本研究決定從臨床研究和動物實驗兩大方向對dexamethasone預防嘔吐之效果與機制作一系列的深入研究。
在臨床方面，本研究在瞭解dexamethasone對由不同週邊神經路徑傳入催吐訊號至嘔吐管制機制（vomiting center），激發嘔吐的預防效果和特性；同時瞭解dexamethasone對麻醉藥物直接刺激延腦（medulla oblongata）的中樞化學接受性催吐區（chemoreceptive trigger zone）整合嘔吐管制機制而激發嘔吐的預防效果和特性，以便將來此研究成果直接於應用臨床，嘉惠病人。研究設計包括：
壹、首先探討dexamethasone能否預防病人接受甲狀腺切除（thyroidectomy）術後嘔吐的效果。以瞭解其阻斷對主要由頸部週邊神經傳入催吐訊號，及部分殘餘麻醉藥物對中樞化學接受性催吐區之刺激，與兩者經整合嘔吐管制機制誘發嘔吐的特性；並求出它的止吐反應曲線（dose-response curve），算出其最佳預防嘔吐的劑量，作為往後研究之重要參考。【第二章】
貳、再為探討dexamethasone能否在接受鼓室乳突切除（tympanomastoidectomy）的病人，亦具有預防術後嘔吐的效果。以瞭解其阻斷對主要由三叉神經、面神經、前庭耳蝸神經、舌咽神經和迷走神經傳入之催吐訊號；及部分殘餘麻醉藥物對中樞化學接受性催吐區的刺激，與及兩者經整合嘔吐管制機制誘發嘔吐的特性。【第三章】
參、最後探討dexamethasone能否預防病人接受腹腔鏡輸卵管結紮（laparoscopic tubal ligation）術後嘔吐的效果，以瞭解其阻斷對主要由下腹部內臟週邊神經傳入之催吐訊號，及部分殘餘麻醉藥物刺激中樞化學接受性催吐區，和兩者經整合嘔吐管制機制誘發嘔吐的特性。【第四章】
在動物實驗方面，以貓作研究對象，目的為排除臨床研究的各種限制，深入釐清dexamethasone預防嘔吐的特性和闡明其作用機制，以期望更能提升其止吐效果，消除病人的痛苦。實驗設計包括：
壹、首先建立胃腸內催吐刺激誘發乾嘔之動物模式，以代表催吐訊號單獨經由週邊神經路徑傳入延腦中嘔吐管制機制而激發乾嘔的真實情形。【第五章】
貳、利用己建立胃腸內催吐刺激誘發乾嘔之動物模式，探討dexamethasone能否具有阻斷單獨經由週邊神經路徑傳入延腦中嘔吐管制機制之催吐訊號，而激發乾嘔的效果和特性；並求出其反應曲線，算出其最佳預防乾嘔的劑量，作為往後實驗之重要參考。【第六章】
參、續而建立催吐藥物（xylazine）刺激中樞化學接受性催吐區誘發嘔吐之動物模式，以代表催吐訊號單獨經由中樞化學接受性催吐區整合嘔吐管制機制，激發嘔吐的真實情形。作為進一步探討dexamethasone能否具有阻斷xylazine刺激中樞化學接受性催吐區整合延腦中嘔吐管制機制，而誘發嘔吐之效果和特性；並求出其反應曲線，算出其最佳預防嘔吐的劑量，作為往後實驗之參考。【第七章】
肆、同時建立一套穩定可靠的方法，在示波器上即時（real time）顯示及記錄胸內靜脈壓（intrathoracic venous pressure）和腹內靜脈壓（intra-abdominal venous pressure）之連串波形變化，所謂示波描記嘔吐模式（oscillographic vomiting model），作為分析乾嘔和嘔吐的方法。應用它獨特專一的波形變化，作為客觀評估胃腸內催吐刺激經由週邊神經傳入延腦中嘔吐管制機制，誘發乾嘔的相關參數；及xylazine刺激延腦中化學接受性催吐區整合嘔吐管制機制，而誘發嘔吐的相關參數。【第八章】
伍、最後以立體定位配以微注射技術（stereotaxic microinjection），參考先前實驗所得dexamethasone最佳預防乾嘔和嘔吐的劑量，注入dexamethasone與其專一拮抗劑的不同推估劑量，於延腦參與嘔吐之相關核區，以示波描記嘔吐模式的實驗裝置記錄胸內靜脈壓和腹內靜脈壓。經由神經藥理學的觀念，客觀評估及闡明dexamethasone預防胃腸內催吐刺激；即單獨阻斷經由週邊神經路徑傳入延腦中嘔吐管制機制之催吐訊號，所激發乾嘔的作用機制【第九章】。另外，同時仿效以上研究策略，闡明 dexamethasone單獨阻斷xylazine刺激中樞化學性接受催吐區，把催吐訊號傳至延腦中嘔吐管制機制而誘發嘔吐的作用機制【第十章】，並與先前連串之實驗的結果一併分析討論。【第十一章】
研究結果顯示，在臨床研究方面，預先使用dexamethasone均能有效降低病人接受甲狀腺切除術、鼓室乳突切除術和腹腔鏡輸卵管結紮術的手術後嘔吐。這結果暗示dexamethasone同時具有阻斷由週邊神經將催吐訊號傳入嘔吐管制機制誘發嘔吐的效果和特性；及阻斷由部分殘餘麻醉藥物所產生之催吐訊號刺激中樞化學接受性催吐區，整合嘔吐管制機制誘發嘔吐的效果和特性。
在動物實驗部分，發展出一個可代表單獨由週邊神經傳入催吐訊號至嘔吐管制機制誘發乾嘔的動物模式；同時也成功建立一個可代表催吐訊號單獨由中樞化學接受性催吐區，整合嘔吐管制機制誘發嘔吐的動物模式。並且証明dexamethasone在貓分別具有單獨阻斷由週邊神經將催吐訊號傳入嘔吐管制機制誘發乾嘔的效果和特性；及單獨阻斷催吐訊號由xylazine刺激中樞化學接受性催吐區整合嘔吐管制機制誘發嘔吐的效果和特性。
另外，本實驗中也成功建立了一套示波描記嘔吐模式，利用其獨特專一的波形變化，作為客觀評估及分辨乾嘔和嘔吐的相關參數。
最後，更進一步利用立體定位配微注射技術証明dexamethasone產生止吐的神經機制是在兩側孤立束核（bilateral nuclei tractus solitarius），並藉由該兩側核區中的糖皮質激素受體（glucocorticoid receptor）參與和完成止吐作用。
總之，本系列性研究，藉由臨床醫學的直接應用與基礎科學的深入探討，對闡明dexamethasone預防嘔吐的特性和確定其神經機制，完成一氣呵成的瞭解，而在此課題有所貢獻。然而，dexamethasone其細胞層次的相關止吐機制，則有待進一步探討。

Vomiting is the utmost one among so many unpleasant experiences of patients receiving surgery, anesthesia, chemotherapy and pain management. Most of the currently used antiemetics are either too expensive or possess clinically significant adverse effects. Therefore, a search for a new antiemetic that has fewer adverse effects yet is effective and economic is a worthwhile effort.
Dexamethasone, a corticosteroid, has been reported to be an antiemetic for chemotherapy-associated vomiting since 1981. Several studies have supported this finding. Although a single dose of dexamethasone is cheap and virtually devoid of adverse effects, little is known about its antiemetic effect for postoperative vomiting. Furthermore, the antiemetic action of dexamethasone has not been elucidated. The purposes of this dissertation are to investigate the clinical application and mechanistic understanding of the antiemetic action of dexamethasone.
In a series of clinical research, we explored whether dexamethasone could block either the peripheral emetic inputs to the vomiting center or the central emetic inputs to the vomiting center, or be capable of blocking both. Moreover, the clinical application of the antiemetic action of dexamethasone was also investigated. The contents of the clinical researches included:
1.Evaluation of the antiemetic effect of dexamethasone in prevention of vomiting after thyroidectomy and its minimum effective dosage for this purpose.
2.Evaluation of the antiemetic effect of dexamethasone in prevention of vomiting after tympanomastoidectomy.
3.Evaluation of the antiemetic effect of dexamethasone in prevention of vomiting after laparoscopic tubal ligation.
In a series of animal studies, we explored the antiemetic mechanism of dexamethasone in cats. The strategies used in these animal studies included the following:
1.First, an animal model of retching induced by emetic stimulation in the gastrointestinal tract was established.
2.Then, the antiemetic effect of dexamethasone was evaluated in the above peripheral emetic animal model.
3.Second, an animal model of xylazine-induced emesis was established. The antiemetic effect of dexamethasone was then evaluated in this central emetic animal model.
4.Third, an oscillographic vomiting model was established. This technique was to record the series of unique intrathoracic venous pressure pulses and intra-abdominal venous pressure pulses generated during retching and vomiting, which could distinguish retching from vomiting.
5.Finally, the specific localization in the medulla oblongata of the antiemtic mechanism of dexamethasone was evaluated having recourse to the methodology of stereotaxic microinjection.
Our results of the clinical researches demonstrated that dexamethasone could reduce vomiting after thyroidectomy, tympanomastoidectomy and laparoscopic tubal ligation. From the clinical point of view, it is suggested that dexamethasone might block either the peripheral emetic inputs to the vomiting center or the central emetic inputs to the vomiting center, even or both. We developed an animal model of retching induced by emetic stimulation of the gastrointestinal tract that could stand for the peripheral emetic inputs to the vomiting center. In contrast, we also established an animal model of xylazine-induced emesis that represented the central emetic inputs to the vomiting center. Furthermore, the results of our animal studies demonstrated that dexamethasone significantly reduced xylazine-induced emesis and retching induced by emetic stimulation in the gastrointestinal tract in cats. It might hint that dexamethasone could block the peripheral emetic inputs to the vomiting center as well as the central emetic inputs to the vomiting center. In addition, we successfully established an oscillographic vomiting model that could distinguish retching from vomiting. Finally, by using the methodology of stereotaxic microinjection, we demonstrated that bilateral nuclei tractus solitarius could be the sites of the antiemetic action of dexamethasone and glucocorticoid receptor might play the pivotal part in this mechanism.
In summary, from the clinical and scientific points of view, we conclude that bilateral nuclei tractus solitarius could be the sites of the antiemetic action of dexamethasone and glucocorticoid receptor play the pivotal part in this mechanism. This cellular mechanism will require further studies and offers a fertile field for future investigations.

封面
第一章、導論
延腦調控嘔吐的重要性
研究動機與目的
實驗假說與策略
第二章、Dexamethasone預防接受甲狀腺切除術病人之術後嘔吐的效果和特性（劑量－效應之研究）
引言
方法
結果
討論
第三章、Dexamethasone預防接受鼓室乳突切除術病人之術後嘔吐的效果和特性
引言
方法
結果
討論
第四章、Dexamethasone預防接受腹腔鏡輸卵管結紮術病人之術後嘔吐的效果和特性
引言
方法
結果
討論
第五章、建立胃腸內催吐刺２淚誘發乾嘔庂動物模式
引言
材料與方法
結果
討論
第六章、Dexamethasone預防胃腸內催吐刺激誘發乾嘔之效果和特性
引言
材料與方法
結果
討論
第七章、Dexamethasone預防催吐藥物xylazine刺激中樞化學接受催吐區誘發嘔吐之效果和特性
引言
材料與方法
結果
討論
第八章、建立示波描記嘔吐模式作為分析乾嘔和嘔吐之方法
引言
材料與方法
結果
討論
第九章、Dexamethasone預防胃腸內催吐刺激誘發乾嘔之中樞機制
引言
材料與方法
結果
討論
第十章、Dexamethasone預防催吐藥物xylazine刺激中樞化學接受催吐區誘發嘔吐之中樞機制
引言
材料與方法
結果
討論
第十一章、總結與展望
總結
未來展望
第十二章、參考文獻
附錄、論文發表的相關文章之目錄

Aapro MS and Alberts DS : Dexamethasone as an antiemetic in patients treated with cisplatin. N. Engl. J. Med. 305 : 520, 1981.
Agarwal MK , Hainque B , Moustaid N and Lazer G : Glucocorticoid antagonists. FEBS Lett. 217 : 221-226, 1987.
Agarwal MK : The antiglucocorticoid action of mifepristone. Pharmacol. Ther. 70 : 183-216, 1996.
Ahima RS and Harlan RE : Charting of type II glucocorticoid receptor-like immunoreactivity in the rat central nervous system. Neuroscience 39 : 579-604, 1990.
Amend F and Klavano PA : Xylazine: a new sedative-analgesic with predictable emetic properties in the cat. Vet. Med. Small Anim. Clin. 68 : 741-744, 1973.
Andrews PLR, Bingham S and Davis CJ : Retching evoked by stimulation of abdominal vagal afferents in the anaesthetized ferret. J. Physiol. 358 : 103P, 1985.
Andrews PLR and Wood KL : Vagally mediated gastric motor and emetic reflexes evoked by stimulation of the antral mucosa in anaesthetized ferrets. J. Physiol. 395 : 1-16, 1988a.
Andrews PLR, Rapeport WG and Sanger GJ : Neuropharmacology of emesis induced by anti-cancer therapy. Trends Pharmacol. Sci. 9 : 334-341, 1988b.
Andrews PLR : Physiology of nausea and vomiting. Br. J. Anaesth. 69 : 2S-19S, 1992.
Andrews P, Torii Y, Saito H and Matsuki N : The pharmacology of the emetic response to upper gastrointestinal tract stimulation in Suncus murinus. Eur. J. Pharmacol. 307 : 305-313, 1996.
Ariumi H, Saito R, Nago S, Hyakusoku M, Takano Y and Kamiya H : The role of tachykinin NK-1 receptors in the area postrema of ferrets in emesis. Neurosci. Lett. 286 : 123-126, 2000.
Barber WD and Burks TF : Brain stem response to phasic distension. Am. J. Physiol. 245 : G242-G248, 1983.
Barber WD and Burks TF : Brain-gut interactions : brain stem neuronal response to local gastric effects of substance P. Am. J. Physiol. 253 : G369-G377, 1987.
Baxendale BR, Vater M and Lavery KM : Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 48 : 961-964, 1993.
Baxter JS and Evans JM : Intramuscular injection in the cat. J. Small Anim. Pract. 14 : 297-302, 1973.
Beleslin DB, Rezvani AH and Myers RD : Rostral hypothalamus: a new neuroanatomical site of neurochemically-induced emesis in the cat. Brain Res. Bull. 19 : 239-244, 1987.
Berman AL : The brain stem of the cat: a cytoarchitectonic atlas with stereotaxic coordinates. Madison, University of Wisconsin Press, 1968.
Bodner M and White PF : Antiemetic efficacy of ondansetron after outpatient laparoscopy. Anesth. Analg. 73 : 250-254, 1991.
Boissonade FM, Sharkey KA and Davison JS : Fos expression in ferret dorsal vagal complex after peripheral emetic stimuli. Am. J. Physiol. 266 : R1118-R1126, 1994.
Borison HL and Wang SC : Functional localization of central coordinating mechanism for emesis in cat. J. Neurophysiol. 12 : 305-313, 1949.
Borison HL and Wang SC : Physiology and pharmacology of vomiting. Pharmacol. Rev. 5 : 193-230, 1953.
Borison HL : Area postrema: chemoreceptor trigger zone for vomiting - is what all? Life Sci. 14 : 1807-1817, 1974.
Borison HL, Borison R and McCarthy LE : Phylogenic and neurologic aspects of the vomiting process. J. Clin. Pharmacol. 21 : 23S-29S, 1981.
Borison HL, Borison R and McCarthy LE : Role of the area postrema in vomiting and related functions. Fed. Proc. 43 : 2955-2958, 1984.
Bountra C, Gale JD, Gardner CJ, Jordan CC, Kilpatrick GJ, Twissell DJ and Ward P : Towards understanding the aetiology and pathophysiology of the emetic reflex: novel approaches to antiemetic drugs. Oncology 53 : 102-109, 1996.
Brizzee KR, Neal LM and Williams PM : The chemoreceptor trigger zone for emesis in the monkey. Am. J. Physiol. 180 : 659-662, 1955.
Brizzee KR : Mechanics of vomiting: a minireview. Can. J. Physiol. Pharmacol. 68 : 221-229, 1990.
Bronzino JD, Morgane PJ and Stern WC : EEG synchronization following application of serotonin to area postrema. Am. J. Physiol. 223 : 376-383, 1972.
Carpenter DO : Neural mechanisms of emesis. Can. J. Physiol. Pharmacol. 68 : 230-236, 1990.
Chai CY, Wang HH, Hoffman BF and Wang SC : Mechanisms of bradycardia induced by digitalis substances. Am. J. Physiol. 212 : 26-31, 1967.
Chai CY, Huang TF and Wang SC : Mechanisms of cardiac arrhythmias induced by baroceptor reflexes in cats. Am. J. Physiol. 215 : 1316-1323, 1968.
Chai CY, Hsu PL and Lee TM : Emetic effects of streptomycin. Arch. Int. Pharmacodyn. Ther. 201 : 300-307, 1973a.
Chai CY, Hsu PL and Wang SC : Central locus of emetic action of digitalis substances in cats. Neuropharmacology 12 : 1187-1193, 1973b.
Cintra A, Zoli M, Rosen L, Agnati LF, Okret S, Wikstrom AC, Gustaffsson JA and Fuxe K : Mapping and computer assisted morphometry and microdensitometry of glucocorticoid receptor immunoreactive neurons and glial cells in the rat central nervous system. Neuroscience 62 : 843-897, 1994.
Colby ED, McCarthy LE and Borison HL : Emetic action of xylazine on the chemoreceptor trigger zone for vomiting in cats. J. Vet. Pharmacol. Ther. 4 : 93-96, 1981.
Derbyshire AJ and Ferguson JKW : Studes on the vomiting reflex in cats and dogs. Am. J. Physiol. 123 : 52-53, 1938.
Ehrlein HJ : Retroperistaltism and duodenogastric reflux in dogs. Scand. J. Gastroenterol. Suppl. 67 : 29-32, 1981.
Ewalenko P, Janny S, Dejonckheere M, Andry G and Wyns C : Antiemetic effect of subhypnotic doses of propofol after thyroidectomy. Br. J. Anaesth. 77 : 463-467, 1996.
Fauser AA, Fellhauer M, Hoffmann M, Link H, Schlimok G and Gralla RJ. Eur. J. Cancer 35 : 361-370, 1999.
Fukui H and Yamamoto M : Methotrexate produces delayed emesis in dogs: a potential model of delayed emesis induced by chemotherapy. Eur. J. Pharmacol. 372 : 261-267, 1999.
Furukawa N, Hatano M, Fukuda H and Koga T : Non-N-methyl-D-aspartate receptors may mediate the transmission of emetic signals between visceral vagal afferents and the solitary nucleus in dogs. Neurosci. Lett. 258 : 53-56, 1998.
Ganong WF : Central regulation of visceral function. in: Review of medical physiology. edited by Ganong WF, Connecticut, Appleton and Lange, 1995, pp. 210.
Gatti PJ, Dias Souza J, Taveira Da Silva AM, Quest JA and Gillis RA : Chemical stimulation of the area postrema induces cardiorespiratory changes. Brain Res. 346 : 115-123, 1985.
Gatti PJ, Dias Souza J and Gillis RA : Increase in coronary vascular resistance produced by stimulating neurons in the region of the area postrema of the cat. Brain Res. 448 : 313-319, 1988.
Goldberg SC : The afferent paths of nerves involved in the vomiting reflex induced by distension of an isolated pyloric pouch. Am. J. Physiol. 99 : 156-159, 1931.
Greene SA and Thurmon JC : Xylazine: a review of its pharmacology and use in veterinary medicine. J. Vet. Pharmacol. Ther. 11 : 295-313, 1988.
Grunberg SM and Hesketh PJ : Control of chemotherapy-induced emesis. N. Engl. J. Med. 329 : 1790-1796, 1993.
Gwyn DG, Leslie RA and Hopkins DA : Gastric afferents to the nucleus of the solitary tract in the cat. Neurosci. Lett. 14 : 13-17, 1979.
Hardy RM : Hypernatremia. Vet. Clin. North. Am. Small. Anim. Pract. 19 : 231-240, 1989.
Henzi I, Walder B and Tramèr MR : Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth. Analg. 90 : 186-194, 2000.
Hikasa Y, Takase K, Saito K and Ogasawara S : Antagonism of the emetic action of xylazine by α-adrenoceptor blocking agents. Eur. J. Pharmacol. 130 : 229-235, 1986.
Hikasa Y, Takase K and Ogasawara S : Evidence for the involvement of α2-adrenoceptors in the emetic action of xylazine in cats. Am. J. Vet. Res. 50 : 1348-1351, 1989.
Ho ST, Wang JJ, Tzeng JI, Liu HS, Ger LP and Liaw WJ : Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study. Anesth. Analg. 92 : 745-748, 2001.
Honkavaara P, Lehtinen AM, Hovorka J and Korttila K : Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle. Can. J. Anaesth. 38 : 876-879, 1991.
Honkavaara P, Saarnivaara L and Klemola UM : Effect of transdermal hyoscine on nausea and vomiting after surgical coorection of prominent ears under gerneral anaesthesia. Br. J. Anaesth. 74 : 647-650, 1995.
Hwang K, Essex HE and Mann FC : A study of certain problems resulting from vagotomy in dogs with special reference to emesis. Am. J. Physiol. 149 : 429-448, 1946.
Italian Group for Antiemetic Research : Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N. Engl. J. Med. 332 : 1-5, 1995.
Italian Group for Antiemetic Research : Double-blind, dose-finding study of four intravenous doses of dexamethasone in the prevention of cisplatin-induced acute emesis. J. Clin. Oncol. 16 : 2937-2942, 1998.
Jones AL, Hill AS, Soukop M, Hutcheon AW, Cassidy J, Kaye SB, Sikora K, Carney DN and Cunningham D : Comparison of dexamethasone and ondansetron in the prophylaxis of emesis induced by moderately emetogenic chemotherapy. Lancet 338 : 483-487, 1991.
Kalia M and Mesulam MM : Brain stem projections of sensory and motor components of the vagus complex in the cat: laryngeal, tracheobronchial, pulmonary, cardiac, and gastrointestinal branches. J. Comp. Neurol. 193 : 467-508, 1980.
Kapur PA : Editorial: the big "little problem". Anesth. Analg. 73 : 243-245, 1991.
Kayashima N, Tarraka M, Iwasaki M and Hayama T : Site of emetic action or oral copper sulfate in dogs. (I) Threshold of various portions of gastrointestinal tract to locally applied copper sulfate. Jpn. J. Pharmacol. 98 : 775-781, 1978.
Keeton RW : Nausea and related sensation elicited by duodenal distension. Arch. Intern. Med. 35 : 687-697, 1925.
King GL : Animal models in the study of vomiting. Can. J. Physiol. Pharmacol. 68 : 260-268, 1990.
Kirkbride P, Bezjak A, Pater J, Zee B, Palmer MJ, Wong R, Cross P, Gulavita S, Blood P, Sun A, Dundas G, Ganguly PK, Lim J, Chowdhury AD, Kumar SE and Dar AR : Dexamethasone for the prophylaxis of radiation-induced emesis: a national cancer institute of Canada clinical trials group phase III study. J. Clin. Oncol. 18 : 1960-1966, 2000.
Kirsten EB and St. John, WM : A feline decerebration technique with low mortality and long-term homeostasis. J. Pharmacol. Methods 1 : 263-268, 1978.
Koga T and Fukuda H : Neurons in the nucleus of the solitary tract mediating inputs from emetic vagal afferents and the area postrema to the pattern generator for the emetic act in dogs. Neurosci. Res. 14 : 166-179, 1992.
Kovac AL : Prevention and treatment of postoperative nausea and vomiting. Drugs 59 : 213-243, 2000.
Ku PK, Tong MC, Lo P and van Hasselt CA : Efficacy of ondansetron for prevention of postoperative nausea and vomiting after outpatient ear surgery under local anesthesia. Am. J. Otol. 21 : 24-27, 2000.
Lang IM, Sarna SK and Condon RE : Gastrointestinal motor correlates of vomiting in the dog: quantification and characterization as an independent phenomenon. Gastroenterology 90 : 40-47, 1986a.
Lang IM, Marvig J, Sarna SK and Condon RE : Mechanism of initiation of the gastrointestinal motor correlates of vomiting activated by luminal stimulation. Gastroenterology 91 : 1059, 1986b.
Lang IM : Noxious stimulation of emesis. Dig. Dis. Sci. 44 : 58S-63S, 1999.
Liu K, Hsu CC and Chia YY : Effect of dexamethasone on postoperative emesis and pain. Br. J. Anaesth. 80 : 85-86, 1998.
Macario A, Weinger M, Carney S and Kim A : Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth. Analg. 89 : 652-658, 1999.
McCarthy LE and Borison HL : Respiratory mechanics of vomiting in decerebrate cats. Am. J. Physiol. 226 : 738-743, 1974a.
McCarthy LE, Borison HL, Spiegel PK and Friedlander RM : Vomiting: radiographic and oscillographic correlates in the decerebrate cat. Gastroenterology 67 : 1126-1130, 1974b.
McCarthy LE and Borison HL : Antiemetic activity of N-methyllevonantradol and nabilone in cisplatin-treated cats. J. Clin. Pharmacol. 21 : 30S-37S, 1981.
Miller AD and Ruggiero DA : Emetic reflex arc revealed by expression of the immediate-early gene c-fos in the cat. J. Neurosci. 14 : 871-888, 1994a.
Miller AD and Leslie RA : The area postrema and vomiting. Front. Neuroendocrinol. 15 : 301-320, 1994b.
Miller AD, Umezaki T, Nakazawa K, Shiba K, Siniaia, MS and Zheng Y : Recovery of retching after lesions involving the nucleus of the solitary tract. Neurosci. Res. 31 : 77-88, 1998.
Miller AD : Central mechanisms of vomiting. Dig. Dis. Sci. 44 : 39S-43S, 1999.
Morimoto M, Morita N, Ozawa H, Yokoyama K and Kawata M : Distribution of glucocorticoid receptor immunoreactivity and mRNA in the rat brain: an immunohistochemical and in situ hybridizaiton study. Neurosci. Res. 26 : 235-269, 1996.
Myles PS, Williams DL, Hendrata M, Anderson H and Weeks AM : Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10811 patients. Br. J. Anaesth. 84 : 6-10, 2000.
Naylor RJ and Rudd JA : Emesis and anti-emesis. Cancer Surv. 21 : 117-135, 1994.
Parry H and Martin K : Single-dose i.v. dexamethasone - an effective anti-emetic in cancer chemotherapy. Cancer Chemother. Pharmacol. 28 : 231-232, 1991.
Rudd JA and Naylor RJ : An interaction of ondansetron and dexamethasone antagonizing cisplatin-induced acute and delayed emesis in the ferret. Br. J. Pharmacol. 118 : 209-214, 1996a.
Rudd JA, Bunce KT and Naylor RJ : The interaction of dexamethasone with ondansetron on drug-induced emesis in the ferret. Neuropharmacology 35 : 91-97, 1996b.
Rudd JA and Naylor RJ : The actions of ondansetron and dexamethasone to antagonise cisplatin-induced emesis in the ferret. Eur. J. Pharmacol. 322 : 79-82, 1997.
Rudd JA, Tse JYH and Wai MK : Cisplatin-induced emesis in the cat: effect of granisetron and dexamethasone. Eur. J. Pharmacol. 391 : 145-150, 2000.
Sam TS, Chan SW, Rudd JA and Yeung JH : Action of glucocorticoids to antagonise cisplatin-induced acute and delayed emesis in the ferret. Eur. J. Pharmacol. 417 : 231-237, 2001.
Schwartz SM, Goldberg MJ, Gidda JS and Cerimele BJ : Effect of zatosetron on epicac-induced emesis in dogs and healthy men. J. Clin. Pharmacol. 34 : 250-254, 1994.
Sharma RN, Dubey PC, Dixit KS, Bhargava KP : Neural pathways of emesis associated with experimental intestinal obstruction in dogs. Indian J. Med. Res. 60 : 291-295, 1972.
Sonner JM, Hynson JM, Clark O and Katz JA : Nausea and vomiting following thyroid parathyroid surgery. J. Clin. Anesth. 9 : 398-402, 1997.
Sousa RJ, Tannery NH and Lafer EM : In situ hybridization mapping of glucocorticoid receptor messenger ribonucleic acid in rat brain. Mol. Endocrinol. 3 : 481-494, 1989.
Splinter WM and Roberts DJ : Dexamethasone decreases vomiting by children after tonsillectomy. Anesth. Analg. 83 : 913-916, 1996.
Stockall CA : Postoperative nausea and vomiting - when will it stop? Can. J. Anaesth. 46 : 715-718, 1999.
Sung YF : Risks and benefits of drugs used in the management of postoperative nausea and vomiting. Drug Saf. 14 : 181-197, 1996.
Szelenyi I, Herold H and Gothert M : Emesis induced in domestic pigs: a new experimental tool for detection of antiemetic drugs and for evaluation of emetogenic potenrial of new anticancer agents. J. Pharmacol. Toxicol. Metheds 32 : 109-116, 1994.
Tanihata S, Igarashi H, Suzuki M and Uchiyama T : Cisplatin-induced early and delayed emesis in the pigeon. Br. J. Pharmacol. 130 : 132-138, 2000.
Tork I, McRitchie DA, Rikard-bell GC and Paxinos G : Autonomic regulatory centers in the medulla oblongata in : The Human Nervous System edited by Paxinos G. San Diego, CA, Academic Press, 1990, pp.221-259.
Ueno S, Matsuki N and Saito H : Suncus murinus: a new experimental model in emesis research. Life Sci. 41 : 513-518, 1987.
van den Berg AA : A comparison of ondansetron and prochlorperazine for the prevention of nausea and vomiting after tympanoplasty. Can. J. Anaesth. 43 : 939-945, 1996.
Velasco M, Landaverde M, Lifshitz F and Parra A : Some blood constituents in normal cats. J. Am. Vet. Med. Assoc. 158 : 763-764, 1971.
Veyrat-Follet C, Farinotti R and Palmer JL : Physiology of chemotherapy-induced emesis and antiemetic therapy: predictive models for evaluation of new compounds. Drugs 53 : 206-234, 1997.
Wang SC and Borison HL : The vomiting center : a critical experimental analysis. Arch. Neurol. Psych. 63 : 928-941, 1950.
Wang SC and Borison HL : Copper sulphate emesis: a study of afferent pathways from the gastrointestinal tract. Am. J. Physiol. 164 : 520-526, 1951.
Wang SC and Chai CY : Central control of sympathetic cardioacceleration in medulla oblongata of the cat. Am. J. Physiol. 202 : 31-34, 1962.
Wang JJ, Ho ST, Liu YH, Ho CM, Liu K and Chia YY : Dexamethasone decreases epidural morphine-related nausea and vomiting. Anesth. Analg. 89 : 117-120, 1999.
Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH and Liao YC : The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth. Analg. 89 : 200-203, 1999.
Wang JJ, Ho ST, Tzeng JI and Tang CS : The effect of timing of dexamethasone administration on its efficacy as a prophylactic for postoperative nausea and vomiting. Anesth. Analg. 91 : 136-139, 2000.
Wang JJ, Ho ST, Wong CS, Tzeng JI, Liu HS and Ger LP : Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can. J. Anaesth. 48 : 185-190, 2001.
Watcha MF and White PF : Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 77 : 162-184, 1992.
Wilson EW : The evolution of methods for female sterilization. Int. J. Gynecol. Obstet. 1 : 3-13, 1995.
Wu WC, Yang CY and Chai CY : Nitric oxide mediates depressor responses by activation of n-methyl-d-aspartate receptors in the nucleus tractus solitarius of cat. Chin. J. Physiol. 43 : 75-80, 2000.
Yates BJ, Grèlot L, Kerman IA, Balaban CD, Jakuš J and Miller AD : Organization of vestibular inputs to nucleus tractus solitarius and adjacent structures in cat brain stem. Am. J. Physiol. 267 : R974-R983, 1994.
Yates BJ, Balaban CD, Miller AD, Endo K and Yamaguchi Y : Vestibular inputs to the lateral tegmental field of the cat: potential role in autonomic control. Brain Res. 689 : 197-206, 1995.
Yates BJ, Miller AD and Lucot JB : Physiological basis and pharmacology of motion sickness: an update. Brain Res. Bull. 47 : 395-406, 1998.
Yuan CS and Barber WD : Brainstem evoked response to dorsal vagal gastric input from the proximal stomach. J. Auton. Nerv. Syst. 31 : 67-73, 1990.
Yuan CS and Barber WD : Area postrema: gastric vagal input from proximal stomach and interactions with nucleus tractus solitarius in cat. Brain Res. Bull. 30 : 119-125, 1993.
Zunini GS, Roth SH and Lucier GE : The inhibitory effect of halothane on the emetic response in the ferret. Can. J. Physiol. Pharmacol. 68 : 374-378, 1990.