Details
Category: Volume 07 Issue 07 July 2019
Hits: 1328

Title: A Comparative study between Ondansetron, Dexamethasone and Propofol forprevention of Intraoperative nausea vomiting in Patients undergoing cesarean section under spinal anesthesia

Authors: Dr Debjani Dutta M.B.B.S, Dr Neetika Mishra M.D, Dr Santanu Ghosh M.D

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.61

Abstract

Background: Control of intraoperative nausea vomiting during caesarean section under spinal anaesthesia is a challenge for every obstetric anaesthesiologist mostly because of its multiple etiology. In this study, the effects of IV Ondansetron (4 mg), Dexamethasone (8mg) and sub hypnotic infusion dose of Propofol were compared for prevention of intraoperative nausea and vomiting during caesarean delivery under spinal anaesthesia.

Materials and Methods: A comparative, double-blinded study was carried out on 90parturient 2nd Gravida parturientby allocating them into three groups using computer-generated method. Group O (n = 30) received intravenous (IV) Ondansetron 4 mg, Group D (n = 30) received (IV) Dexamethasone 8 mg and Group P (n= 30) received Propofol 10 mg IV bolus followed by an IV infusion of 1mg/kg/hr respectively after the delivery of baby and clamping the cord. Intraoperative emetic episodes were observed, and safety assessments were performed by an investigator, and propofol infusion was stopped at the end of surgery. Chi-square test and ANOVA were used for statistical analysis wherever appropriate and P < 0.05 was considered significant.

Results: The maternal demographics and operative management were comparable among the three groups. The incidence of nausea, retching, and vomiting in the intraoperative, post-delivery period were: Group O: Group D: Group P Nausea 58.6% versus 10.3% and 20.6%   P = 0.000; Retching 44.8% versus 13.8% and 24.1% P = 0.027, Vomiting 41.3%, 13.7%, versus 17.4% P = 0.028. No clinically significant adverse events were observed among the groups.

Discussion: The IV dexamethasone 8 mg and IV Propofol 10 mg bolus followed by infusion of propofol 1 mg/kg/h is better than IV Ondansetron 4 mg for reduction of the incidence of nausea, retching, and vomiting in the caesarean section under spinal anesthesia.

Keywords: Antiemetic, caesarean delivery, ondansetron, dexamethasone, propofol, spinal anesthesia

References

  1. Balki M, Carvalho A. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth 2005;14:230‑41.
  2. Santos A, Datta S. Prophylactic use of droperidol for control of nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1984;63:85‑7.
  3. Borgeat A, Wilder‑Smith OH, Wilder‑Smith CH, Forni M, Suter PM. Propofol improves patient comfort during cisplatin chemotherapy. A pilot study. Oncology 1993;50:456‑9.
  4. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77:162‑84.
  5. Pan PH, Moore CH.Intraoperative antiemetic efficacy of prophylactic ondansetron versus droperidol for cesarean section patients under epidural anesthesia. AnesthAnalg1996;83:982-6.
  6. Scher CS, Amar D, McDowall RH, Barst SM. Use of propofol for the prevention of chemotherapy‑induced nausea and emesis in oncology patients. Can J Anaesth 1992;39:170‑2.
  7. Borgeat A, Wilder‑Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol possess direct antiemetic properties. AnesthAnalg1992;74:539‑41.
  8. Schulman SR, Rockett CB, Canada AT, Glass PS. Long‑term propofol infusion for refractory postoperative nausea: A case report with quantitative propofol analysis. AnesthAnalg1995;80:636‑7.
  9. FujiiY, NumazakiM. Dose‑range effects of propofol for reducing emetic symptoms during cesarean delivery. Obstet Gynecol 2002;99:75‑9.
  10. Zou Z, Jiang Y, Xiao M, Zhou R. The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy: a systematic review and meta analysis. PloS One 2014; 357: e109582.
  11. Abouleish E I, Rashid S, Haque S, Giezentanner A, Joynton P, Chuang A Z. Ondansetron versus placebo for the control of nausea and vomiting during caesarean section under spinal anaesthesia. Anaesthesia 1999; 54: 479–482.
  12. Balki M, Kasodekar S,  Dhumne S, Carvalho C. A. The Prophylactic Granisetron Does Not Prevent Postdelivery Nausea and Vomiting During Elective Cesarean Delivery Under Spinal Anesthesia. Anesth Analg2007;104:679 –83.
  13. Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anesthesia for cesarean section. Br J Anaesth2004;92:469 –74.
  14. Ratra CK, Badola RP, Bhargava KP. A study of factors concerned in emesis during spinal anaesthesia. Br J Anaesth1972;44:1208‑11.
  15. Fujii Y, Nakayama M. Prevention of PONV with a small dose of propofol alone and combined with dexamethasone in patients undergoing laparoscopic cholecystectomy. Clin Ther 2004;8: 1286‑91.
  16. Numazaki M, Fujii Y. Subhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesth Intensive Care 2000;28:262‑5.
  17. Numazaki M, Fujii Y. Reduction of emetic symptoms during cesarean delivery with antiemetics: Propofol at subhypnotic dose versus traditional antiemetics. J Clin Anesth2003;15:423‑7.
  18. Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994;81:1005‑43.
  19. Cechetto DF, Diab T, Gibson CJ, Gelb AW. The effects of propofol in the area postrema of rats. Anesth Analg 2001;92:934‑42.
  20. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology1982;56:68‑70.
  21. Gan TJ, Ginsberg B, Grant AP, Glass PS. Double‑blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology 1996;85: 1036‑42.
  22. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: A randomized double‑blind placebo‑ controlled trial. Ann Surg 2003; 238:651‑60.
  23. Jaffarpour M, Khani A, Dyrekvandmoghadam A, Khajavikhan J, Saadipour KH. The effect of dexamethasone on nausea, vomiting and pain in parturients undergoing caesarean delivery. J Clin Diagn Res 2008;3:854‑8.
  24. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone‑alphadolone. Br Med J 1974;2:656‑9.
  25. Fischer SP. Pre‑operative evaluation. In: Lars IE, Lee AF, Jeanie PW, WilliamL Y, Miller RD, editors. Miller’s Anaesthesia. 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1001‑66.
  26. Hvarfner A, Hammas B, ThörnSE, Wattwil M. The influence of propofol on vomiting induced by apomorphine. Anesth Analg1995;80:967‑9.

Corresponding Author

Dr Neetika Mishra M.D

Associate Professor, Department of Anaesthesiology, North Bengal Medical College