THIAGO RAMOS GRIGIO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Olanzapine as an add-on, pre-operative anti-emetic drug for postoperative nausea or vomiting: a randomised controlled trial(2023) GRIGIO, T. R.; TIMMERMAN, H.; MARTINS, J. V. B.; SLULLITEL, A.; WOLFF, A. P.; SOUSA, A. M.Postoperative nausea or vomiting occurs in up to 40% in patients with multiple risk factors, despite prophylaxis. Olanzapine is an antipsychotic drug that is used to prevent nausea and vomiting in palliative care and to treat chemotherapy-induced nausea and vomiting. This study aimed to examine whether pre-operative olanzapine, as a prophylactic anti-emetic added to intra-operative dexamethasone, ondansetron and total intravenous anaesthesia, reduced the incidence of postoperative nausea or vomiting. We performed a multiply-blinded randomised controlled trial in patients aged 18-60 years with cancer at high risk of postoperative nausea or vomiting (three or four risk factors according to the Apfel criteria) plus a previous history of chemotherapy-induced nausea and vomiting. Patients were allocated at random to receive 10 mg olanzapine or placebo orally 1 h before surgery in addition to a two-drug regimen (dexamethasone and ondansetron) and propofol anaesthesia to prevent postoperative nausea or vomiting. The primary outcome was the incidence of postoperative nausea or vomiting in the first 24 h after surgery. In total, 100 patients were enrolled; 47 in the olanzapine group and 49 in the control group completed the study. The baseline characteristics of the groups were similar. The incidence of postoperative nausea or vomiting in the first 24 h after surgery was lower in the olanzapine group (12/47, 26%) than in the control group (31/49, 63%) (p = 0.008, RR 0.40 (95%CI 0.21-0.79)). Adding pre-operative oral olanzapine to intra-operative dexamethasone and ondansetron was highly effective in reducing the risk of postoperative nausea or vomiting in the first 24 hours after surgery in patients with a previous history of chemotherapy-induced nausea and vomiting and at least three Apfel risk factors for postoperative nausea or vomiting.
- Cancer pain treatment during the COVID-19 pandemic: institutional recommendations(2020) SOUSA, Angela Maria; GRIGIO, Thiago Ramos; ASHMAWI, Hazem Adel; RIBEIRO JUNIOR, Ulysses
- Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial(2020) GRIGIO, Thiago Ramos; SOUSA, Angela Maria; MAGALHAES, Gabriel Guimaraes Nunes; ASHMAWI, Hazem Adel; VIEIRA, Joaquim EdsonOBJECTIVES: To evaluate the addition of a fourth antiemetic intervention in patients at high risk for postoperative nausea and vomiting (PONV). METHODS: High-risk patients (Apfel score 3 or 4) scheduled for unilateral mastectomy were randomly allocated in one of two groups, oral aprepitant (oral aprepitant 80 mg, intravenous dexamethasone 8 mg, and palonosetron 0.075 mg) and oral placebo (oral placebo, intravenous dexamethasone 4 mg, and palonosetron 0.075 mg). Patients and caregivers were blinded to the group assignments. The primary efficacy endpoints included the incidence of nausea and vomiting, and the secondary endpoints included use of rescue antiemetics during a 48-hour postoperative period. ClinicalTrials.gov: NCT02431286. RESULTS: One hundred patients were enrolled in this study and 91 were analyzed, 48 in group A and 43 in group P. No patient presented with nausea or vomiting in the first 2 hours after surgery. From the 2nd to the 6th hour, the incidence of PONV was 8.33% in group A and 9.30% in group P. In the first 24 hours, the incidence of PONV was 27.08% in the group A and 20.93% in group P. From the 24th to the 48th hour, the incidence of PONV was 8.33% in group A and 13.95% in group P. There were no statistically significant differences in PONV between groups. CONCLUSION: The addition of aprepitant as a third antiemetic resulted in no significant reduction in the incidence of PONV in this population. However, the incidence of PONV was reduced in relation to the general population.
- Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: a double-blind, randomized trial(2018) MORAIS, L. C. de; SOUSA, A. M.; FLORA, G. F.; GRIGIO, T. R.; GUIMARAES, G. M. N.; ASHMAWI, H. A.BackgroundPost-operative nausea and vomiting (PONV) is one of the most important causes of patient discomfort after laparoscopic surgeries despite the use of a multimodal pharmacological approach. This study assessed whether the addition of aprepitant to a multimodal regimen would further decrease the incidence of PONV in high-risk patients. MethodsApfel-score three or four patients, scheduled for laparoscopic procedures to treat abdominal or pelvic cancer, were randomized to receive oral starch (control group) or 80 mg of oral aprepitant (treatment group) before induction of anaesthesia in a double-blind study. All patients received 4-8 mg of intravenous dexamethasone (at induction) and 4-8 mg of ondansetron (at the end) and a standardized total intravenous anaesthesia (TIVA) technique combined with neuraxial blockade. PONV was defined as any episode of nausea, vomiting or retching in the first 24 h after anaesthesia. ResultsSixty-six patients completed the study. Vomiting occurred in 13/32 (40.6%) patients in the control group and in 1/34 (2.9%) patients in the treatment group (P = 0.0002, 95%CI: 18-54%) in the first 24 h after anaesthesia. Severe nausea occurred in two (6.3%) patients, and severe vomiting occurred in four (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 post-operative hours. ConclusionEighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements. This study was registered in the ClinicalTrials.gov (NCT 02357693) database.
bookPart Analgesia regional para o tratamento da dor(2019) HYODO, Hideki; GRIGIO, Thiago Ramos; PEREZ, Marcelo Vaz; TOMMASO, Rafael Reis DibookPart Anti-inflamatórios e relaxantes musculares(2019) PEREZ, Marcelo Vaz; GRIGIO, Thiago Ramos; HYODO, Hideki; TOMMASO, Rafael Reis DibookPart Avaliação do risco e medidas de prevenção de náuseas e vômitos(2018) SOUSA, Angela Maria; GRIGIO, Thiago RamosbookPart Analgesia regional para o tratamento da dor(2022) HYODO, Hideki; GRIGIO, Thiago Ramos; PEREZ, Marcelo Vaz; TOMMASO, Rafael Reis DibookPart Anti-inflamatórios e relaxantes musculares(2022) PEREZ, Marcelo Vaz; GRIGIO, Thiago Ramos; HYODO, Hideki; TOMMASO, Rafael Reis Di