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Background: Walking is typically the preferred form of physical activity among lung cancer patients. Physical activity can promote and maintain the health of such patients., Objective: We examined how walking affected the quality of life (QOL) of lung cancer patients, evaluating the factors that predicted changes in walking during a 6-months study., Methods: This study involved a longitudinal and correlational design, and the instruments comprised the Godin Leisure-Time Exercise Questionnaire, the Functional Assessment of Cancer Therapy-Lung Cancer, and social support and self-efficacy scales., Results: In total, 107 patients were evaluated for 6 months; the results indicated that the patients completed approximately 217 to 282 minutes of walking per week. The data demonstrated that the frequency of walking exercise decreased or stopped among 36% patients during the 6-month study. A generalized estimating equation analysis indicated significant differences between the Functional Assessment of Cancer Therapy-Lung Cancer scores and levels of physical and functional well-being among the lung cancer patients who did and did not engage in walking. Social support, self-efficacy, and patient treatment status can be used to predict the change in walking among lung cancer patients., Conclusion: Patient QOL can be improved by engaging in walking exercise for 6 months. Regarding lung cancer patients, social support and self-efficacy are the key factors in maintaining walking exercise., Implications for Practice: Integrating psychological strategies may be required to strengthen the positive effects of walking exercise on the QOL of lung cancer patients.

Background: Lung cancer patients undergo various treatments leading to sleep problems, rest-activity circadian rhythms disruption, and reduced levels of physical activity. It is important to understand the relationships among these variables. Appropriate interventions can possibly be implemented to improve sleep quality in lung cancer patients., Objective: The objective of this study was to examine the relationships of circadian rhythms and physical activity with objective sleep parameters in 106 of Taiwanese lung cancer patients., Methods: This study used a cross-sectional design. The instruments included an actigraph to measure the objective sleep parameters (total sleep time [TST], sleep efficiency, and sleep-onset latency [SOL]), rest-activity circadian rhythms (r24 [24-hour autocorrelation coefficient] and I < O [in-bed less than out-of-bed dichotomy index]), and physical activity frequency (UP activity mean). The daily physical activity amount in minutes was measured by the Bouchard 3-day physical activity record., Results: Patients performing light-intensity physical activity of 295 min/d or greater had better values for the TST, sleep efficiency, SOL, r24, and I < O than those performing less than 295 min/d (all P < .05). Significant predictors of the TST included age (β = -.31), I < O (β = .32), and UP activity mean (β = -.42). Predictors of the SOL included current treatment (β = .20), I < O (β = -.28), UP activity mean (β = .51), and 24-hour light-activity minutes (β = -.23)., Conclusions: Marked circadian rhythms and adequate light-intensity physical activity may improve sleep quality in lung cancer patients., Implications for Practice: Adequate light-intensity physical activity can be an effective intervention to improve sleep quality in lung cancer patients.

Background: Haloperidol, a major tranquilizer, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the prophylactic effect of haloperidol plus dexamethasone on PONV has not been evaluated. We evaluated the prophylactic effect of haloperidol plus dexamethasone to either given alone, placebo or droperidol on PONV in patients undergoing a laparoscopic-assisted vaginal hysterectomy., Methods: Four hundred adult women (n = 80 in each of five groups) scheduled for a laparoscopic-assisted vaginal hysterectomy were enrolled in a randomized, double-blind, placebo, and positive-control study. Fifteen minutes after the induction of anesthesia, patients received an i.v. injection of either saline (group S), droperidol 1.25 mg (group D), haloperidol 2 mg (group H), dexamethasone 5 mg (group Dx), or haloperidol 2 mg plus dexamethasone 5 mg (group H + Dx) to prevent PONV. The occurrence of PONV and medication-related side effects were recorded., Results: The incidences of PONV (0-24 h) in the D (36%), H (37%), Dx (38%), and H + Dx (19%) groups were significantly lower than in the S group (65%; P < 0.05 for each comparison). The H + Dx group had the lowest incidence of PONV (19%; P < 0.05 for each comparison) of the five study groups. No differences were found between the D, H, and Dx groups. Also, no differences were found among the five groups in the side effects of QT prolongation, intensity of postoperative pain, level of sedation, and occurrence of extra-pyramidal symptoms., Conclusion: Prophylactic haloperidol 2 mg plus dexamethasone 5 mg produced a greater reduction in the incidence of PONV than did either drug used alone, placebo or droperidol without increasing perioperative adverse outcomes.

Background: Dextromethorphan blocks sodium channels, the site of action of local anesthetics. In this study we evaluated whether dextromethorphan has a local anesthetic effect., Methods: We administered dextromethorphan and its active metabolite--dextrorphan, and lidocaine subcutaneously to rats and tested them for cutaneous anesthesia. Drug-drug interactions and systemic safety indices (LD50s/ED50s) were also evaluated., Results: Dextromethorphan and dextrorphan had a local anesthetic effect after cutaneous infiltration. The ranking of potencies was dextromethorphan > dextrorphan > lidocaine (P < 0.01 for each comparison). A combination of dextromethorphan or dextrorphan with lidocaine produced an additive effect. Dextromethorphan and dextrorphan had 2.4- and 1.9-fold higher system safety indices than did lidocaine., Conclusion: Dextromethorphan and dextrorphan were more potent local anesthetics than lidocaine, but with higher systemic safety indices. Coadministration of dextromethorphan or dextrorphan with lidocaine produced an additive effect.

Background: Local anesthetics, when applied to nerves, produce reversible loss of sensation by blocking Na+ channels. Because all Class I antiarrhythmic drugs are Na+ channel blockers, theoretically, they may have local anesthetic effects. In this study, we sought to define the cutaneous local anesthetic actions of three Class I antiarrhythmic drugs., Methods: Using a subcutaneous infiltration model in rats, the potencies and durations of action of quinidine (Class IA), mexiletine (IB), and flecainide (IC) were determined and compared with the actions of lidocaine and bupivacaine. Saline injection was used as control., Results: Three Class I antiarrhythmic drugs produced a dose-related cutaneous analgesia with ranking of potencies of bupivacaine > flecainide > quinidine > mexiletine > lidocaine (P < 0.05 for the differences among drugs). On an equipotent basis, the ranking of durations of action was flecainide > quinidine and bupivacaine > mexiletine and lidocaine (P < 0.05 for the differences among drugs)., Conclusion: Three Class I antiarrhythmic drugs, quinidine (IA), mexiletine (IB), and flecainide (IC) have a local anesthetic effect on cutaneous analgesia.

An analgesic with a prolonged duration may be desirable in patients with long-lasting pain. In this study, we evaluated the antinociceptive effects and durations of action of three novel depots of buprenorphine esters buprenorphine propionate, enanthate, and decanoate given by IM injection, in rats. The pharmacokinetic profiles of buprenorphine in blood after IM injection of these depots were also evaluated. Antinociception was evaluated using the plantar test. Buprenorphine concentrations in blood were assayed using high-performance liquid chromatography. We found that the traditional form of buprenorphine HCl (in saline) produced a dose-related antinociceptive effect. A dose of 0.6 micromol/kg buprenorphine HCl (in saline) produced a significant antinociceptive effect lasting 5 h. The same dose of buprenorphine base, propionate, enanthate, and decanoate (in oil) also produced a significant antinociceptive effect with longer durations of action of 26, 28, 52, and 70 h, respectively. The pharmacokinetic studies demonstrated that all the buprenorphine esters were prodrugs of buprenorphine. We conclude that the novel depots of buprenorphine prodrugs: buprenorphine propionate, enanthate, and decanoate produced a long-acting antinociceptive effect after IM injection in rats.

No long-acting nonsteroidal antiinflammatory drug is clinically available for the treatment of pain. In this study, we evaluated the antinociceptive and antiinflammatory effects and duration of action of several novel depots of ketorolac esters, such as ketorolac propyl ester, pentyl ester, heptyl ester, and decyl ester, and observed whether they had a long-acting effect. Four studies in Sprague-Dawley rats were performed. In Studies 1-3, the antinociceptive and antiinflammatory effects of IM ketorolac tromethamine and its base and propyl ester were evaluated. In Study 4, the antinociceptive and antiinflammatory effects of several other ketorolac esters were evaluated. We found that ketorolac tromethamine 24, 80, and 240 micromol/kg (in saline) produced significant antinociceptive and antiinflammatory effects with duration of action of approximately 6-8 h. The four ketorolac esters at a dose of 240 micromol/kg (in oil) produced significant long-acting antinociceptive and antiinflammatory effects, with duration of action of approximately 52-76 h. We concluded that IM injection of novel depots of ketorolac esters in rats produce long-acting antinociceptive and antiinflammatory effects that are 6.5- to 9.5-fold longer than the traditional dosage form of ketorolac tromethamine.

Unlabelled: Dexamethasone is an effective antiemetic drug, but the efficacy of small-dose dexamethasone 5 mg on the prophylaxis of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy has not been evaluated. We, therefore, evaluated the prophylactic effect of small-dose dexamethasone (5 mg) on PONV in patients undergoing laparoscopic cholecystectomy. Tropisetron and saline served as controls. One-hundred-twenty patients scheduled for laparoscopic cholecystectomy were enrolled in a randomized, double-blinded, placebo-controlled study. At the induction of anesthesia, the Dexamethasone group received IV dexamethasone 5 mg, the Tropisetron group received IV tropisetron 2 mg, and the Placebo group received IV saline. We found that both dexamethasone and tropisetron significantly decreased the following variables: the total incidence of PONV (P < 0.01), more than four vomiting episodes (P < 0.05), and the proportions of patients requiring rescue antiemetics (P < 0.05). The differences between the Dexamethasone and Tropisetron groups were not significant. We conclude that prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing laparoscopic cholecystectomy. At this dose, dexamethasone is as effective as tropisetron 2 mg and is more effective than placebo., Implications: We evaluated the prophylactic effect of small-dose dexamethasone (5 mg) on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. Tropisetron (2 mg) and saline served as controls. We found that dexamethasone 5 mg (IV) significantly reduced the incidence of PONV in these patients, and, at this dose, dexamethasone was as effective as tropisetron and was more effective than placebo.

Unlabelled: Tropisetron is a 5-hydroxytryptamine subtype 3 receptor antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. We evaluated the prophylactic effect of tropisetron on postoperative nausea and vomiting associated with epidural morphine. Dexamethasone and saline served as controls. One-hundred twenty women (n = 40 in each of three groups) undergoing abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blinded, and placebo-controlled study. At the end of surgery, Group 1 received IV tropisetron 5 mg, whereas Groups 2 and 3 received dexamethasone 5 mg and saline, respectively. We found that tropisetron did not significantly reduce the occurrence of nausea and vomiting associated with epidural morphine. Dexamethasone, however, reduced the total incidence of nausea and vomiting from 59% to 21% (P < 0.01) and the percentage of patients requiring rescue antiemetic from 38% to 13% (P < 0.05). We conclude that IV tropisetron 5 mg did not prevent the occurrence of postoperative nausea and vomiting associated with epidural morphine. IV dexamethasone 5 mg was effective for this purpose., Implications: We compared the prophylactic IV administration of tropisetron 5 mg to prevent postoperative nausea and vomiting (PONV) associated with epidural morphine with dexamethasone 5 mg and saline in women undergoing hysterectomy. We found that tropisetron 5 mg did not significantly reduce the occurrence of PONV associated with epidural morphine. Dexamethasone 5 mg was effective for this purpose.