Patients will receive standard of care behavior and nutritional interventions. They will not receive cyproheptadine.

Patients will receive standard of care behavior and nutritional interventions. They will receive cyproheptadine every day for a total of two months. Standard dose of 0.25 mg/kg divided BID will be used.

Patients will receive standard of care behavior and nutritional interventions. They will receive cyproheptadine every day for two weeks cycled with no cyproheptadine given for two weeks for a total of two months. Patients on cycled dosing will be given cyproheptadine for two weeks, then no medication for two weeks; repeating this cycle for the two month duration of study

No Cyproheptadine Treatment

Patients will receive standard of care behavior and nutritional interventions. They will receive cyproheptadine every day for a total of two months. Standard dose of 0.25 mg/kg divided BID will be used.
Cyproheptadine

Continuous Cyproheptadine

Patients will receive standard of care behavior and nutritional interventions. They will receive cyproheptadine every day for two weeks cycled with no cyproheptadine given for two weeks for a total of two months. Patients on cycled dosing will be given cyproheptadine for two weeks, then no medication for two weeks; repeating this cycle for the two month duration of study
Cyproheptadine

Cycled Cyproheptadine

Total

Sex: Female, Male

Region of Enrollment

Participants' guardians will complete the Mealtime Behavior Questionnaire (MBQ). This is a validated, 31-item, parent-report questionnaire assessing the mealtime behavior structure in young children above 2 years. The questionnaire measures variables including: 1) food refusals/avoidance; 2) food manipulation; 3) mealtime aggression and 4) choking/gagging/vomiting related to meals. Each behavior is assigned a frequency scale with 1 corresponding to "never" and 5 corresponding to "always." The MBQ then consist of a total score and four subcategory scores (listed above).

Feeding Behavior Questionnaire

Change in skin fold thickness as measured by centimeters and z-score percentiles

Anthropometrics: Skin Fold Thickness

Change in mid-arm circumference as measure by centimeters and z-score percentiles

Anthropometrics: Mid-arm Circumference

Change in BMI as measured by kilograms divided by meters squared and z-score percentiles

Anthropometrics: BMI

Change in height as measured in centimeters and z-score percentiles

Anthropometrics: Height

Change in weight as measured in kilograms and z-score percentiles

Anthropometrics: Weight

Patients will answer affirmative or negative to a descriptive list of side effects commonly experienced when taking cyproheptadine. Examples of these descriptive variables include nausea, emesis, etc. Percentage of patients experiencing each side effect will be calculated and compared across the course of study.

Percentage of Participants Experiencing Side Effects From Cyproheptadine

Change in calorie intake will be recorded

24 Hour Diet Recall

Overall Study

Praveen Goday

Feeding Behaviors

Cyproheptadine

Effects of Cyproheptadine on Growth and Behavior in Pediatric Feeding Disorders

Professor of Pediatric Gastroenterology

Medical College of Wisconsin

Sugammadex 2 mg/Kg will be administrated as a single dose via intravenous injection upon completion of surgery and guided by peripheral nerve stimulation.
The drug is to be diluted with normal saline to make up to 5 ml volume to maintain blinding.

Neostigmine 0.040 mg/Kg, along with Atropine 0.015 mg/kg, diluted in normal saline to make up 5 ml total volume to maintain blinding.
Neostigmine 0.040 mg/Kg, along with Atropine 0.015 mg/kg will be administrated as a single dose via intravenous injection upon completion of surgery and guided by peripheral nerve stimulation for reversal of neuromuscular blockade produced during surgery.
Atropine sulfate-diphenoxylate hydrochloride combination will be an adjuvant drug to balance muscarinic side effects of Neostigmine, when Neostigmine is administered.

Postoperative Nausea and Vomiting

Sugammadex

Neostigmine

KK Women's and Children's Hospital

Sugammadex Versus Neostigmine for Postoperative Nausea and Vomiting After Laparoscopic Gynaecological Surgery

Comparison of Sugammadex Versus Neostigmine in Women at High Risk of Postoperative Nausea and Vomiting After Laparoscopic Gynaecological Surgery: A Randomized Controlled Trial

Incidence of self-reported, postoperative nausea at 24-hours after neuromuscular blockade reversal with sugammadex or neostigmine, in women at high-risk of PONV, after undergoing laparoscopic gynaecological surgery.

Incidence of self-reported PONV following administration of Sugammadex or Neostigmine reversal for neuromuscular blockade 6-hours following laparoscopic gynaecological surgery in women at high-risk of PONV.

Severity of self-reported PONV after administration of Sugammadex or Neostigmine for neuromuscular blockade reversal at 6-hours and 24-hours after undergoing laparoscopic gynaecological surgery in women at high-risk of PONV.

Pain intensity after administration of Sugammadex or Neostigmine for neuromuscular blockade reversal in women at high-risk for PONV at 6-hours and 24-hours following laparoscopic gynaecological surgery.

Quality of recovery score after administration of Sugammadex or Neostigmine for neuromuscular blockade reversal in women at high-risk of PONV at 24 hours following laparoscopic gynaecological surgery.

Deepak Mathur

Consultant Anaesthetist

Singhealth Foundation

Antibiotic-Associated Diarrhea

Clostridium Difficile

4 mg PO initially and 2 mg after each water stoll not to exceed 10 mg qd

loperamide

placebo

VAMC

Efficacy of Loperamide for C. Difficile Colitis and Other Diarrheal Diseases Associated With Antibiotic Therapy

Study of the Efficacy of Loperamide in Treating Patients for Clostridium Difficile Colitis and Diarrheal Disease of Unknown Cause Associated With Prior Antibiotic Therapy.

atropine/diarrhea

Effects of Cyproheptadine on Growth and Behavior in Pediatric Feeding Disorders

Sugammadex Versus Neostigmine for Postoperative Nausea and Vomiting After Laparoscopic Gynaecological Surgery

Efficacy of Loperamide for C. Difficile Colitis and Other Diarrheal Diseases Associated With Antibiotic Therapy

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