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    Over sedating

    It is a common response to motion stimuli during travel.Although nausea is a hallmark symptom, the syndrome includes symptoms ranging from vague malaise to completely incapacitating illness.Alternatively, slow, intermittent habituation to motion is an effective strategy to reduce symptoms.1 For example, spending the first night aboard a boat in the marina, followed by a day acclimating in the harbor, is preferable to going straight into the open ocean.A small study found that focusing on the true horizon (skyline) minimized symptoms of motion sickness.5 A survey of 3,256 bus passengers suggested that forward vision was helpful in reducing symptoms.3 Another study indicated that forward vision in a car can reduce symptoms.4Actively steering the vehicle is an accepted strategy for reducing symptoms of motion sickness, although evidence is limited.7 Additionally, a small study of automobile passengers found that actively tilting the head into turns was effective in preventing symptoms.6 A survey of 260 cruise ship passengers supported the common advice to recline and passively stabilize themselves if they are unable to initiate active movements.8Frequent consumption of light, soft, bland, low-fat, and low-acid food can minimize symptoms of motion sickness.2 Treating gastritis is useful,2 as is avoiding nausea-inducing stimuli (e.g., alcohol, noxious odors).If they must travel, they should sit in the part of the vehicle with the least amount of rotational and vertical motion.2 This is usually the lowest level in trains and buses, close to water level and in the center of boats, and over the wing on airplanes.With continuous exposure to motion, symptoms of motion sickness will usually subside in one to two days.Adding a second patch of transdermal scopolamine was well tolerated in a small RCT of 20 sailors.25First-generation antihistamines have been used to treat motion sickness since the 1940s.1 They are generally recommended for patients who can tolerate their sedative effects.219 Nonsedating antihistamines are not effective in preventing or treating motion sickness.26Benzodiazepines are occasionally administered for severe symptoms of motion sickness and have been proven effective in a single small study.27 The serotonin agonist rizatriptan (Maxalt) reduced motion sickness symptoms in a single RCT of 25 patients with recurrent migraines.28 The serotonin antagonist ondansetron (Zofran) is ineffective for the prevention and treatment of motion sickness.2930Although ginger root is often reported to prevent motion sickness, it had no statistically significant effects in an RCT of 80 naval cadets.31 A single RCT of pregnant women showed that stimulation of the P6 acupressure point on the anterior wrist increased their tolerance of motion stimuli.32 Controlled trials of behavioral, pharmacologic, or alternative therapies for motion sickness have demonstrated strong placebo effects.Therefore, treatments are likely to be most effective if the patient believes that they will work.11: Pub Med was searched using the Me SH headings motion sickness, ships, movement, space motion sickness, and travel.

    over sedating-26

    CHIP GRESHAM, MD, FACEM, FAAEM, is an emergency medicine physician and medical toxicologist at Middlemore Hospital.Scopolamine is a first-line medication for prevention of motion sickness and should be administered transdermally several hours before the anticipated motion exposure.First-generation antihistamines, although sedating, are also effective.Patients should learn to identify situations that will lead to motion sickness and minimize the amount of unpleasant motion they are exposed to by avoiding difficult conditions while traveling or by positioning themselves in the most stable part of the vehicle.Slow, intermittent exposure to the motion can reduce symptoms.

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