Abstract
Purpose
The mechanism of the antiemetic actions of corticosteroids is not known. The purpose of this study was to evaluate if betamethasone can prevent nausea, vomiting or increase of vasopressin induced by apomorphine. Metoclopramide, a dopamine antagonist, was used as a control substance.
Methods
Te n healthy volunteers were studied on three occasions. In a randomized order they were allocated to receive pretreatment with betamethasone 8 mgiv, metoclopramide 10 mgiv, and normal saline 2 mL as placebo on the three different occasions, 15 min before the administration of apomorphine 30 μg·kg-1 sc. After administration of apomorphine, episodes of vomiting were recorded, and the intensity of nausea was estimated by the subject on a visual analogue scale (VAS 0-10 cm). Blood samples for analysis of plasma concentrations of vasopressin were analyzed.
Results
One volunteer decided to withdraw, as he experienced akathisia after receiving metoclopramide. During the first two hours after apomorphine, eight of nine volunteers vomited both after betamethasone and placebo. One volunteer did not vomit after betamethasone and placebo but he experienced nausea. None of the volunteers vomited after metoclopramide (P < 0.01 vs betamethasone and placebo). The maximum VAS for nausea was significantly higher after betamethasone and placebo compared to metoclopramide (P < 0.01). The vasopressin levels increased after betamethasone and placebo, but there was no increase in any volunteer after pretreatment with metoclopramide.
Conclusion
This study demonstrates that betamethasone does not prevent nausea, vomiting and increase of vasopressin induced by apomorphine, whereas metoclopramide prevents apomorphine-induced emesis. Our work suggests that betamethasone does not have dopamine-antagonistic effects.
Résumé
Objectif
Le mécanisme des actions antiémétiques des corticoïdes n’est pas connu. Nous voulions évaluer si la bêtaméthasone peut prévenir les nausées, et les vomissements ou ľaugmentation de la vasopressine induits par ľapomorphine. Le métoclopramide, un antagoniste de la dopamine, a été utilisé comme substance témoin.
Méthode
Dix volontaires sains ont été étudiés en trois occasions. Répartis au hasard, ils ont reçu un prétraitement avec 8 mg de bêtaméthasone iv, 10 mg de métoclopramide iv et 2 mL de solution salée comme placebo, 15 min avant ľadministration de 30 μg·kg-1 ďapomorphine sc. Après ľadministration ďapomorphine, les épisodes de vomissements ont été enregistrés et ľintensité des nausées estimée par le sujet sur une échelle visuelle analogique (EVA 0-10 cm). Des échantillons sanguins ont été analysés pour les concentrations plasmatiques de vasopressine.
Résultats
Un volontaire a décidé de se retirer, car il a manifesté de ľacathisie après avoir reÇu le métoclopramide. Pendant les deux premières heures après ľapomorphine, huit volontaires ont vomi après avoir reÇu la bêtaméthasone et le placebo. Un volontaire n’a pas eu que des nausées. Aucun n’a vomi après avoir reÇu le métoclopramide (P < 0,01 vs bêtaméthasone et placebo). Le score maximal à ľEVA pour les nausées a été significativement plus élevé après la bêtaméthasone et le placebo comparés au métoclopramide (P < 0,01). Les niveaux de vasopressine se sont élevés après la bêtaméthasone et le placebo, mais non chez les volontaires prétraités avec le métoclopramide.
Conclusion
La bêtaméthasone ne peut prévenir les nausées, les vomissements et ľaugmentation de vasopressine induits par ľapomorphine, tandis que le métoclopramide empêche les vomissements induits par ľapomorphine. Notre étude montre que la bêtaméthasone n’a pas ďeffets antagonistes sur la dopamine.
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Axelsson, P., Thörn, SE., Lövqvist, Å. et al. Betamethasone does not prevent nausea and vomiting induced by the dopamine-agonist apomorphine. Can J Anesth 53, 370–374 (2006). https://doi.org/10.1007/BF03022501
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DOI: https://doi.org/10.1007/BF03022501