Title: Comparative study of subhypnotic dose of propofol alone and combined with dexamethasone for control of emetic episodes under spinal anaesthesia for caesarean section delivery

Authors: Dr Pramila Soni, Dr Kiwi Mantan, Dr Anita Pareek, Mr Aditya

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.49

Abstract

Introduction: Nausea, retching and vomiting are common and distressing for parturient undergoing cesarean delivery perform under regional anaesthesia. In recent years, various anti-emetic agents has been used for treatment of intraoperative and post-operative nausea and vomiting. None of the currently available antiemetic regimes are entirely effective and many are associated themselves with unpleasant side effects.

Material and Methods: This Randomized prospective study was conducted on 60 cases. Female patients ranging 20-45yrs (ASA I or II) at term undergoing cesarean section with spinal anaesthesia were included in this study.

Patients were randomly allocated into three groups (N= 20 each) to receive:

  1. Group I: Infusion of inj. Propofol 1mg/kg/hr
  2. Group II: Inj. Dexamethasone 8mg with infusion of injpropofol 1mg/kg/hr
  3. Group III: Infusion of normal saline 1mg/kg/hr

Results: No statistically significant differences were found in pre-anaesthetic check-up parameters among the three groups. 35% patients in propofol group, 10% in Group II and 85% in control group show intraoperative symptoms (p<0.001). 85% patients in control group, 10% in propofol group and 5% in Group II had postoperative symptoms (p<0.001). The difference was found insignificant (p>0.05). Sedation seen in one patient in propofol group and one patient in propofol+dexona group. No other adverse effects were found in any group.

Conclusion:  We conclude that propofol given at subhypnotic dose infusion with dexamethasone is safe and more effective in controlling perioperative emetic symptoms compared to propofol or control group without increase in significant side effects in patient undergoing cesarean section under spinal anaesthesia.

Keywords: Dexamethasone, Propofol, Dexamethasone, Subhypnotic

References

  1. Santos A., Datta S.: Prophylactic uses of droperidol for control of nausea and vomiting during spinal anaesthesia for caesarean section. AnesthAnalg 1984; 63:85-7.
  2. Lussos S.A., Bader A.M., Thornhill M.L., Datta S.: The antiemetic efficacy and safety of prophylactic metroclopramide for elective cesarean section delivery during spinal anaesthesia. Reg. anaesthesia 1992; 17:126-30.
  3. Balki M., Carvalho J.C.A.: Intraoperative nausea and vomiting during cesarean section under regional anaesthesia. International Journal of Obstratric Anaesthesia 2005; 14:230-241.
  4. Beattie WS, Lindblad T, Buckley DN et al: The incidence of post-operative nausea and vomiting undergoing laparoscopy is influenced by the day of mensural cycle. Can J Anaesth 1991; 38:298-302.
  5. Kenny GN.: Risk factors for postoperative nausea and vomiting. Anesthesia 1994; 49 (Suppl): 6-10.
  6. Yoshitaka Fujii and Mitsuko Numazaki: Dose range effects of propofol for reducing emetic symptoms during cesarean delivery. Obs. Gynecol. 2002; 99:75-9.
  7. Alahuhta S, Kangas-Saarela T, Hollmen AI et al: Visceral pain during caesarean delivery under spinal and epidural anaesthesia with bupivaicaine. ActaAnaesthesiolScand 1990; 34:95-8.
  8. Fuji Y. and Numazaki M.: Comparison of subhypnotic dose of propofol alone and combined with dexamethasone for emesis in parturiants undergoing cesarean delivery. Clinical therapeutics August 2004; 26(8):1286-1291.
  9. Fuji Y. and Numazaki M.: Dexamethasone for reduction of nausea, vomiting and analgesic use after gynecological laparoscopic surgery. International Journal of Gynecology and Obstetrics 2008; 100:27-30.
  10. Rudra A., Halder R., Sen A.: Efficacy of low dose propofol for control of emetic episodes during cesarean delivery with subarachnoid block anaesthesia. Indian Journal of Anaesthesia 2004; 48(1):31-34.
  11. Bianchin A., Luca A.D., Caminiti A.: Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone. Minerva anestesiologica Journal 2007 July; 73(6):343-6.
  12. Jaafarpour M. et al: The effect of dexamethasone on nausea, vomiting and pain in parturients undergoing cesarean delivery. Journal of clinical and diagnostic research 2008 June (2); 3:854-858.
  13. Fuji Y. and Numazaki M.: Prevention of postoperative nausea and vomiting with a small dose of propofol alone and combined with dexamethasone in patients undergoing laparoscopic cholecystectomy. Surg. Endosc. 2013 June; 27(6):2251.
  14. Numazaki M. and Fuji Y.: Antiemetic efficacy of propofol at small doses for reducing nausea and vomiting following thyroidectomy. Can. J. Anaesth. 2013 June; 60(6):606.

Corresponding Author

Dr Kiwi Mantan

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