***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Metoclopramide , a drug used for the relief of nausea and emesis , is currently under development as a radio- and chemosensitizing agent . Its usefulness in high doses , however , is limited by its central nervous system side effects . Neu-metoclopramide ( Neu-Sensamide ) , a novel , concentrated , phosphate-buffered , pH-adjusted ( pH = 6.5 - 7.0 ) formulation of metoclopramide , has been shown to have an improved side-effect profile in animal studies . The present double-blind , four-way crossover study compared the central nervous system effects and pharmacokinetics of neu-metoclopramide ( intravenously and intramuscularly at 1.8 mg/kg ) with intravenous metoclopramide and intramuscular placebo in 19 healthy male volunteers . Eight participants withdrew from the study , one because of noncompliance and seven because of adverse events .  A total of 28 central nervous system events were observed with intravenous metoclopramide administration , whereas 16 , 15 , and 6 such events were attributed to intravenous neu-metoclopramide , intramuscular neu-metoclopramide , and placebo , respectively . Extra-pyramidal effects occurred on 10 occasions : 7 after intravenous metoclopramide , 2 after intravenous neu-metoclopramide , and 1 after intramuscular neu-metoclopramide . No significant differences were observed in the pharmacokinetic profiles of the three formulations of metoclopramide . It may be speculated , therefore , that the molecular conformational changes inherent to neu-metoclopramide result in a reduced side-effect profile compared with conventional metoclopramide formulations This prospect i ve clinical trial evaluates the feasibility and safety of  elective cholecystectomy  in a simulated outpatient protocol in 40 patients . Results were compared with a 19-patient control group managed by conventional postoperative methods . Oral liquids were begun in the recovery room , intravenous fluids were discontinued 4 hours after surgery , and enteral analgesics and antiemetics were provided on the ward . Protocol patients were r and omized in a double-blind fashion to receive metoclopramide or placebo after surgery to assess its influence on the early tolerance of oral intake . In the protocol group , nausea without emesis occurred in nine patients ( 23 % ) ; 11 others ( 28 % ) had nausea with emesis . This was not significantly different from the control group . Metoclopramide-treated patients did not demonstrate a lower incidence of nausea or emesis but did tolerate oral liquids earlier after surgery than the placebo group ( P less than 0.05 ) . After release from recovery , eight protocol patients ( 20 % ) requested parenteral narcotics for relief of pain . Postoperative urinary catheterization was required in nine protocol patients ( 23 % ) and five control patients ( 26 % ) . No major complications occurred . Outpatient cholecystectomy  is both feasible and safe .  Metoclopramide may allow earlier tolerance of enteral liquids postoperatively During the past decade the dem and for outpatient surgery has grown rapidly . Postoperative nausea and vomiting is one of the more common undesirable consequences of surgery , which may significantly delay the patient 's discharge from the ambulatory surgery center . None of the currently used antiemetic drugs is considered totally effective in abolishing nausea or vomiting . The purpose of this study was to compare the efficacy of ondansetron , a highly selective 5-hydroxytryptamine subtype-3 receptor antagonist , with that of metoclopramide for the prevention of postoperative emesis in patients undergoing cataract surgery . The incidence of postoperative nausea was significantly less in the ondansetron group than that in the metoclopramide group ( p = 0.046 ) . Although the incidence of vomiting was clinical ly less frequent in the ondansetron group , there were no significant differences between both treatment groups . To our knowledge , this is the first study to demonstrate that ondansetron is effective to prevent postoperative emesis after extracapsular cataract extraction STUDY OBJECTIVE To evaluate and compare the preinduction effects of intravenously ( IV ) administered cimetidine alone and combined with metoclopramide on gastric contents and postoperative nausea and vomiting in out patients undergoing elective surgery . DESIGN Patients were allocated r and omly to 4 groups with 20 patients in each group . SETTING Ambulatory surgery at a university-affiliated city hospital . PATIENTS Eighty patients undergoing elective gynecologic or orthopedic procedures were studied . INTERVENTIONS Out patients in Group 1 and in patients in Group 2 served as controls . Out patients in Group 3 received 300 mg of cimetidine , and out patients in Group 4 received 300 mg of cimetidine and 10 mg of metoclopramide . All drugs were administered IV as an infusion over a 15-minute period , 30 to 45 minutes prior to induction of anesthesia . MEASUREMENTS AND MAIN RESULTS After induction of general anesthesia and endotracheal intubation , stomach contents were retrieved and volume and pH measured . Group 1 out patients had a large residual gastric volume of 29.2 + /- 15.9 ml , with a very low pH of 2.32 + /- 1.23 and 15 % frequency of postoperative vomiting . These patients are at high risk of developing significant pneumonitis in the event of the aspiration of gastric contents . The combination of cimetidine and metoclopramide in Group 4 provided the optimal , or safest , condition -- i.e . , high gastric pH [ 6.15 + /- 0.71 ( p less than 0.005 ) ] and low gastric volume [ 11.6 + /- 7.37 ml ( p less than 0.001 ) ] , with no postoperative vomiting . CONCLUSIONS The combination of cimetidine and metoclopramide given to ambulatory patients during the preinductive phase may prevent severe pulmonary consequences should aspiration occur and is more effective in this regard than cimetidine alone In a study of the effectiveness of high intravenous doses of metoclopramide as an antiemetic , 41 patients with advanced cancer who were being treated with cisplatin  were entered into two double-blind trials . In the first trial patients were r and omly assigned to receive either metoclopramide or placebo , and in the second trial they received either metoclopramide or prochlorperazine . Patients given metoclopramide had significantly fewer episodes of emesis than patients given placebo ( medians , 1.0 vs. 10.5 ; P = 0.001 ) or prochlorperazine ( medians , 1.5 vs. 12.0 ; P = 0.005 ) . Metoclopramide was superior to placebo and to prochlorperazine in reducing the volume of emesis ( P = 0.001 and P = 0.022 , respectively ) and was more effective than placebo in shortening the duration of nausea ( P = 0.042 ) and vomiting ( P = 0.028 ) . Side effects from metoclopramide were minor , with mild sedation frequently observed ; one patient had a brief extrapyramidal reaction . We conclude that metoclopramide in high intravenous doses has greater antiemetic activity than placebo or prochlorperazine in patients receiving cisplatin chemotherapy Prevention and treatment of postoperative nausea and vomiting with ephedrine , droperidol and metoclopramide have been reported to be effective . To further investigate their efficacy , 100 pediatric patients scheduled to undergo inguinal hernioplasty on ambulatory basis were divided into five groups , namely , group 1 : normal saline ( iv ) control ; group 2 : ephedrine 0.5 mg/kg , ( i m ) ; group 3 : droperidol 50 micrograms/kg . ( iv ) ; group 4 : ephedrine 1 mg/kg . ( i m ) ; group 5 : metoclopramide 0.15 mg/kg . ( iv ) . At the end of surgery , each patient received the drug treatment according to the specified group to which he was r and omly assigned . The occurrence of postoperative nausea and vomiting was recorded in the recovery room and inquired at home by telephone within 24 h following surgery by a blinded observer . The authors found that there were no significant differences between the control group and ephedrine groups with whichever dose that was used in the prevention of postoperative nausea and vomiting .  Droperidol and metoclopramide were effective in dealing with problem in comparison with control group ( p less than 0.05 ) . However , metoclopramide was more suitable than droperidol for pediatric outpatient based on duration of somnolence , return of orientation , and time of discharge The efficacy of intravenous metoclopramide in controlling vomiting in children after tonsillectomy was determined in a prospect i ve r and omized , double-blind investigation . One hundred two unpremedicated , ASA physical status I or II children between the ages of 1 and 15 yr who were undergoing surgical removal of the tonsils , with or without adenoidectomy , were studied . Anesthesia was induced either with halothane , nitrous oxide , and oxygen by mask or by intravenous thiopental and was maintained with halothane , nitrous oxide , oxygen , and intravenous morphine ( 0.1 mg/kg ) . Each child r and omly received either 0.15 mg/kg of metoclopramide or saline solution placebo intravenously after transfer to the postanesthesia care unit . All episodes of vomiting were recorded for 24 h after completion of surgery . The incidence of vomiting in the saline solution group was 70 % , compared with 47 % in the metoclopramide group ( P = 0.026 ) . The authors conclude that the administration of intravenous metoclopramide in a dose of 0.15 mg/kg on arrival in the postanesthesia care unit significantly decreases the incidence of vomiting in children after tonsillectomy Summary and Conclusions A double-blind comparison of a placebo , metoclopramide , and trimethobenzamide was carried out on 284 adult patients who were scheduled for elective major upper abdominal surgery under methoxyflurane-nitrous-oxide anaesthesia .  The drugs were given intravenously , according to a r and om assignment number code , approximately 30 minutes before the end of an operation . Vital signs and other signs and symptoms were observed by a trained nurse and were recorded for six hours after the test drug was administered . Each patient ’s record was review ed 24 hours after the operation to obtain follow-up data .Metoclopramide ( 20 mg . ) and trimethobenzamide ( 300 mg . ) were not better than the placebo with respect to the incidence of nausea and vomiting during the first twenty-four hours after an operation in the patients that didnot have nasogastric suction . The patients who had nasogastric suction postoperatively had at least 50 per cent lower incidence of nausea and vomiting . This effect was particularly prominent in the patients who received metoclopramide . In approximately one-third of the patients who developed nausea and vomiting , these symptoms were associated with the prior administration of a narcotic analgesic within four hours whether or not they received a potentially active anti-emetic drug . Neither metoclopramide nor trimethobenzamide appeared to have any undesir-able effect on the respiration , circulation , or rate of recovery from methoxy-flurane anaesthesia . On the basis of this study , it appears that neither of the anti-emetic compounds is effective in reducing the incidence of nausea and vomiting associated with the administration of methoxyflurane-nitrous-oxide anaesthesia for major upper abdominal operations . The administration of narcotic analgesic drugs appeared to be an initiating factor in about one-third of the patients who developed nausea and vomiting postoperatively . The only treatment which appeared to reduce the incidence of this complication effectively was the application of nasogastric suction . RéSUMéOn a fait une étude comparée d’un placebo , de la métoclopramide et de la triméthobenzamide chez 284 adultes qui devaient subir une intervention élective majeure dans la moitiv supérieure de l’abdomen sous anesthésie au méthoxy-flurane-protoxyde-d’azote . Les produits , désignés seulement par un numéro , étaient donnés par voie veineuse environ 30 minutes avant la fin de l’opération . Durant les six heures qui suivaient l’administration du produit , une infirmiére compétente enregistrait les signes vitaux et les autres signes ou symptômes qui se produisaient . On revisait le dossier de chaque malade 24 heures après l’opération pour receuillir les données observées . La métoclopramide ( 20 mg . ) et la triméthobenzamide ( 300 mg . ) n’etaient pas supérieures au placebo en regard de la fréquence des nausées et des vomissements durant les premières 24 heures qui suivaient l’opération , chez les malades qui n’étaient pas soumis à l’spiration naso-gastrique . Les malades soumis à l’aspiration voyaient diminuer d’au moins 50 pour cent les nausées et les 
    Output:
    
There was no evidence of dose-responsiveness with oral , i.m . ,
intranasal or i.v .
Minor drug-related adverse effects ( sedation , dizziness , drowsiness ) were not significantly associated with metoclopramide .