Intraoperative Nausea Research Articles

Comparative evaluation of two doses of phenylephrine infusion to prevent intra-operative nausea and vomiting during elective obstetric spinal anesthesia

Comparative evaluation of two doses of phenylephrine infusion to prevent intra-operative nausea and vomiting during elective obstetric spinal anesthesia

Single low-dose ketamine infusion for women with prenatal depressive symptoms undergoing cesarean delivery: A pilot randomized trial.

Ketamine is approved for antidepressant therapy, but evidence regarding its use in women with perinatal depression is lacking. Herein, we investigated the effects of low-dose ketamine in women with prenatal depressive symptoms and tested the feasibility of a future large randomized trial. This was a randomized, double-blind, placebo-controlled pilot trial. Sixty-six women with prenatal depressive symptoms who were scheduled for elective cesarean delivery were randomized to receive either low-dose ketamine (0.5 mg/kg) or placebo (normal saline). The study drugs were intravenously infused over a 40-minute period after clamping the umbilical cord. The primary outcome was depression score assessed with the Edinburgh Postnatal Depression Scale at 48 h postpartum. Among other and safety outcomes, occurrence of nausea or vomiting was observed, pain intensity was assessed with the numeric rating scale. The feasibility of implementing the protocol was also evaluated. A total of 64 parturients were included in the intention-to-treat analysis. The depression score at 48 h did not differ between groups: median 9 (interquartile range 6 to 13) with ketamine vs. 8 (6 to 10) with placebo; median difference 1, 95% CI -1 to 3; P = 0.608. The pain intensity at 4 h postpartum was less severe in the ketamine group (median difference -1, 95% CI -1 to 0, P = 0.002). Among safety outcomes, intraoperative nausea or vomiting was less common in patients given ketamine (0.0% [0/33] with ketamine vs. 21.2% [7/33] with placebo, P = 0.011). Recruitment was satisfactory and the protocol was acceptable to participants and clinicians. A single low-dose ketamine infusion did not decrease the depression score at 2 days, but reduced intraoperative nausea and vomiting and lowered pain intensity at 4 h after cesarean delivery among women with prenatal depressive symptoms. The study protocol is feasible for a large randomized trial. The study was registered with ClinicalTrials.gov (identifier: NCT03336541; 08/11/2017).

Uterine Exteriorization Versus In Situ Repair in Cesarean Delivery: A Systematic Review and Meta-Analysis

(Can J Anesth/J Can Anesth. 2022;69:216–2123) Optimizing surgical technique is an important part of improving outcomes in cesarean delivery. It is unclear whether uterine exteriorization is associated with hemostasis benefits, and if there is a benefit, it is unclear if that outweighs the risks of nausea and vomiting. This review aimed to compare uterine exteriorization for cesarean delivery with in situ repair. The primary outcome of the study was intraoperative nausea and vomiting (IONV) and decrease in hemoglobin concentration.

Implementation of Enhanced Recovery After Caesarean Section (ERACS) in Elective Procedure : A Case Report

<p><strong>Background</strong>: Enhanced Recovery After Cesarean Section (ERACS) protocol includes every component of the pre-operative, intra-operative and post-operative pathway. In the pre-operative phase, the protocol applied to this patient included the shortest possible fasting interval, oral intake of liquid carbohydrate and patient counselling. For intra-operative pathway, the components applied are prevention of hypotension, maintenance of normothermia, optimal uterotonic administration, IONV (intra-operative nausea and vomiting)/PONV (post-operative nausea and vomiting) prophylaxis, multi-modal analgesia and optimization of fluid administration. Post-operatively, the patient was given early nutritional intake, early mobilization, urinary catheter removal, venous thrombo-embolism prophylaxis, multi-modal analgesia and glycemic control. ERACS prove useful for early discharge, improving outcomes such as breastfeeding or reducing post-discharge opioid use.</p><p><strong>Case Illustration</strong>: A 31-year-old woman came with the chief complaint of fluid discharge since ± 3 hours prior to admission to the hospital. Based on the medical history, physical examination, and laboratory findings, the patient was diagnosed with premature rupture of membranes in a gestational age of 37-38 weeks and had a live, single-headed presentation of the fetus. Patient’s physical status is ASA II and scheduled for elective C-section procedure with spinal anesthesia.</p><p><strong>Conclusion</strong>: The implementation of the ERACS protocol in this case has been shown to reduce the rate of infection and post operative complications as well as reducing length of stay for the mother.</p>

Epidural administration of 2% Mepivacaine after spinal anesthesia does not prevent intraoperative nausea and vomiting during cesarean section: A prospective, double-blinded, randomized controlled trial.

Background:Intraoperative nausea and vomiting (IONV) is a common symptom during cesarean section (CS) delivery causing significant discomfort to patients. Combined spinal and epidural anesthesia (CSEA) can provide both intraoperative anesthesia and postoperative analgesia. During CSEA, it is reasonable to administer local anesthetics to the epidural space before patient complaints to compensate for the diminished effect of spinal anesthesia. Therefore, we hypothesized that intraoperative epidural administration of 2% mepivacaine would reduce the incidence of IONV.Methods:Patients who were scheduled for elective CS were randomly allocated to 2 groups. Patients and all clinical staff except for an attending anesthesiologist were blinded to the allocation. After the epidural catheter was inserted at the T11–12 or T12–L1 interspace, spinal anesthesia was performed at the L2–3 or L3–4 interspace to intrathecally administer 10 mg of 0.5% hyperbaric bupivacaine. Twenty min after spinal anesthesia, either 5 mL of 2% mepivacaine (group M) or saline (group S) was administered through an epidural catheter. Vasopressors were administered prophylactically to keep both the systolic blood pressure ≥ 80 % of the baseline value with the absolute value ≥ 90 mm Hg and the mean blood pressure ≥ 60 mm Hg. The primary endpoint was the incidence of IONV. The secondary endpoints were degree of nausea, the degree and incidence of pain, and Bromage score.Results:Ninety patients were randomized, and 3 patients were excluded from the final analysis. There was no significant difference in the incidence of IONV between the groups (58% in group M and 61% in group S, respectively, P = .82). In contrast, the incidence and degree of intraoperative pain in group M were significantly lower compared to group S. In addition, the incidence of rescue epidural administration of fentanyl (18% vs 47%) or mepivacaine (2.3% vs 25%) for intraoperative pain was lower in group M compared to group S.Conclusions:Our results indicate that epidural administration of 2% mepivacaine 20 minutes after spinal anesthesia does not reduce the incidence of IONV in CS under CSEA. However, intraoperative epidural administration of 2% mepivacaine was found to improve intraoperative pain.

Association between intraoperative end-tidal carbon dioxide and postoperative nausea and vomiting in gynecologic laparoscopic surgery

Gynecologic laparoscopic surgery has a high incidence of postoperative nausea and vomiting (PONV). Studies suggest that low intraoperative end-tidal carbon dioxide (EtCO2) is associated with an increased incidence of PONV, but the results have not been consistent among studies. This study investigated the association between intraoperative EtCO2 and PONV in patients undergoing gynecologic laparoscopic surgeries under general anesthesia. This retrospective cohort study involved patients who underwent gynecologic laparoscopic surgeries under general anesthesia at Kyoto University Hospital. We defined low EtCO2 as a mean EtCO2 of < 35 mmHg. Multivariable modified Poisson regression analysis examined the association between low EtCO2 and PONV during postoperative two days and the postoperative length of hospital stay (PLOS). Of the 739 patients, 120 (16%) had low EtCO2, and 430 (58%) developed PONV during postoperative two days. There was no substantial association between low EtCO2 and increased incidence of PONV (adjusted risk ratio: 0.96; 95% confidence interval [CI] 0.80–1.14; p = 0.658). Furthermore, there was no substantial association between low EtCO2 and prolonged PLOS (adjusted difference in PLOS: 0.13; 95% CI − 1.00 to 1.28; p = 0.816). Intraoperative low EtCO2, specifically a mean intraoperative EtCO2 below 35 mmHg, was not substantially associated with either increased incidence of PONV or prolonged PLOS.

MATERNAL SATISFACTION TOWARDS SPINAL ANAESTHESIA FOR CAESAREAN SECTION

ABSTRACT Background There has been an increase in the use of spinal anaesthesia for Caesarean section (CS) in Nigeria in the past decades. There is, therefore, a need to evaluate the level of satisfaction among patients that had spinal anaesthesia, as an index of the quality of reproductive health care. Methodology A prospective observational study of 380 consenting parturients in ASA classes I, II, and III, who underwent CS under spinal anaesthesia between January and December 2019. Satisfaction score was assessed using a three-point Likert scale. Data were analysed using [IBM SPSS software version-22]. The level of statistical significance was set at p-value <0.05. Results A total of 380 consenting patients underwent spinal anaesthesia within the study period with 219 (57.6%) aged ≥30 years. Most were emergency CS 267 (70.3%). Most patients 294 (77.4%) expressed satisfaction for being involved in decision-making about the choice of anaesthesia technique. The majority of the patients 333 (87.6%) were satisfied with pain relief during the operation. The complications experienced by the patients intraoperatively included dizziness, 50 (13.2%), shivering, 139 (36.6%), and intraoperative nausea and vomiting, 48 (12.6%). Overall, 295 (77.6%) of the patients expressed willingness to have spinal anaesthesia again in the future, out of the 295, 293 (99.4%) were satisfied with the current spinal anaesthesia. P = 0.000 Conclusion Maternal satisfaction to spinal anaesthesia in this study was high. This could be attributed to patient’s participation in decision-making, prompt treatment of complications, and overall good anaesthetic care.

Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide\xa0during cesarean section under spinal anesthesia: a randomized controlled trial

BackgroundAbrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section.MethodsA randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, patients scheduled for elective cesarean section were equally randomized to receive either IV HBB 20 mg in 1 ml (Hyoscine group) or the same volume of 0.9% saline (Control group), one minute after spinal anesthesia. The primary endpoint was the incidence of intraoperative bradycardia (HR < 50 beats min−1). Secondary endpoints included changes in mean arterial blood pressure (MAP), the incidence of Intraoperative and Postoperative nausea or vomiting (IONV & PONV), the fetal heart rate and, Apgar score.ResultsOf the 160 subjects randomized, 80 received HBB and 80 received placebo. There was a significant reduction in the incidence of the primary endpoint of intraoperative bradycardia (HR < 50 beats min−1) in the Hyoscine group (0% vs 10%; OR = 0.05, 95% CI = [0.003, 0.93]; P = 0.004) compared with placebo. MAP showed an insignificant difference between groups over time. HBB significantly decreased incidences of IONV and PONV (p = 0.002 & 0.004) respectively.ConclusionsIn parturients undergoing cesarean section under spinal anesthesia, pretreatment with intravenous HBB was a safe measure for both the mother and the baby to reduce the risk of severe intraoperative bradycardia, but not hypotension. Furthermore, it was associated with less incidence of both IONV and PONV.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04069078

SAFETY AND EFFICACY ANTIEMETIC EFFECT OF INTRAVENOUS PALONOSETRON AND ONDANSETRON FOR THE PREVENTION OF INTRA-OPERATIVE NAUSEA AND VOMITING FOLLOWING SPINAL ANAESTHESIA DURING CESEAREAN SECTION.

BACKGROUND AND OBJECTIVE Intra-operative nausea and vomiting is one of the most common complications in patients undergoing spinal anaesthesia for cesearean section . This study is done to know the efficacy and safety of administration of palonosetron and ondansetron in the prevention of intra operative nausea and vomiting in patients undergoing spinal anaesthesia for cesearean section. MATERIAL AND METHODS After obtaining the approval of institutional ethical committee a prospective observational study was conducted for one years on 60 patients belonging to American Society of anaesthesiologists grade I and II ( ASA I and II ) patients aged between 19 to 30 years scheduled for cesearean section under spinal anaesthesia, the patients who fulfil the inclusion and exclusion criteria and willing to participate in the study were included in the study.60 patients fulfilling the inclusion and exclusion criteria were divided into two groups Group A (patients receiving inj. palonosetron 75 micrograms I.V.) and Group B (patients receiving inj. ondansetron 4 milligrams I.V.) before the induction of anaesthesia. Standard anaesthetic management was done in all cases. Incidence of intra operative nausea and vomiting was recorded in all patients for the efficacy of palonosetron to ondansetron in the prevention of intra operative nausea and vomiting was evaluated. Data was evaluated statistically using MS Exel 2007 and MS Word 2007,mean,SD,and percentages generated. RESULT AND CONCLUSION Both group A and group B had comparable demographic profile [(age, weight ASA grade, duration of surgery). At the conclusion of the study it was found that the prophylactic usage of inj. Palonosetron 75 mcg I.V. is more effective than inj. ondansetron in the prevention of intra operative nausea and vomiting in patients undergoing spinal anaesthesia for cesearean section.

Mephentermine vs. Phenylephrine for Prevention and Management of Maternal Hypotension during Caesarean Section under Spinal Anaesthesia and their Effects on Foetal Outcome- A Randomised Control Trial

Introduction: For the best maternal and foetal outcome during caesarean section under spinal anaesthesia, maintaining Systolic Blood Pressure (SBP) at 100% of the baseline is necessary. Mephentermine and Phenylephrine are both sympathomimetic drugs used for timely correction of maternal hypotension. Aim: To compare the effect of intravenous bolus administration of mephentermine and phenylephrine for prevention and management of maternal hypotension and to evaluate the foetal outcome. Materials and Methods: In this randomised double-blinded controlled trial, a total of 150 American Society of Anaesthesiologist (ASA) II scheduled for elective Lower Segment Caeserean Section (LSCS) were randomly allocated into three groups to receive the study drugs: group A received mephentermine 6 mg in 2 mL Normal Saline (NS), group B received phenylephrine 100 mcg in 2 mL NS, and group C received 2 mL NS immediately following subarachnoid block. Whenever hypotension occurred (Systolic Blood Pressure (SBP) &lt;90 mm Hg) rescue boluses were given. Maternal haemodynamic parameters, umbilical cord blood gases, and complications were recorded from the time of sub-arachnoid block till the end of surgery. Results: There was no significant difference in the maternal haemodynamics and neonatal outcome among the three groups. It was observed that phenylephrine had quick peak effect, higher foetal umbilical pH and better neonatal outcome though statistically insignificant. Incidence of significant bradycardia (16%) and absence of intraoperative nausea and vomiting were also reported among group B. None of the neonate had APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score &lt;7 and the umbilical pH was comparable in all the three groups (p &gt;0.05). The time of first rescue vasopressor and the total volume of requirement was earlier and higher in group C with the mean timing of 5.87±4.37 min and mean volume of 2.68±1.58 mL respectively. Conclusion: There is a significant improvement of arterial blood pressures and better neonatal outcome observed when phenylephrine (100 mcg) and mephentermine (6 mg) are given as a prophylactic intravenous (i.v.) bolus dose immediately after subarachnoid block; especially in the initial time period between skin incision and delivery of the baby. When given as a prophylactic i.v. bolus, it had the advantage of lesser total dose requirement of the vasopressor used and better haemodynamic maintenance till the delivery of the baby

Metoclopramide and Propofol to Prevent Nausea and Vomiting during Cesarean Section under Spinal Anesthesia: A Randomized, Placebo-Controlled, Double-Blind Trial.

Background: Intra-operative nausea, vomiting and retching (NVR) are frequently associated with subarachnoid anesthesia (SA) in women undergoing cesarean section (CS). In this study performed in women undergoing CS under SA with a risk factor control strategy, we compared saline (placebo), propofol, metoclopramide and both drugs to prevent NVR. Methods: We recorded NVR events in 110 women undergoing CS who were randomized after umbilical cord clamping to receive saline (S; n = 27), metoclopramide 10 mg (M; n = 28), propofol 1 mg/kg/h (P; n = 27) or both drugs (PM; n = 28). Results: The proportion of women with intra-operative nausea was: S: 17/27 (63%); P: 15/27 (56%); M: 13/28 (46%); PM: 6/28 (21%) (p = 0.012, Cramér’s V = 0.31 (large effect). The proportion of women with intra-operative vomiting/retching was: S: 9/27 (33%); M: 7/27 (25%); P: 3/28 (11%); PM 2/28 (7%) (p = 0.049, Cramér’s V = 0.26 (medium effect). Post-hoc multiple comparisons revealed a significant reduction in NVR episodes and NRS scores between the PM group and control. Sedation scores did not differ among groups. Conclusion: In women undergoing CS under SA with a risk factor control strategy, combined propofol and metoclopramide reduce nausea and vomiting.

Uterine exteriorization versus in situ repair in Cesarean delivery: a systematic review and meta-analysis.

We conducted an updated systematic review and meta-analysis on maternal outcomes associated with uterine exteriorization compared with in situ repair in women undergoing Cesarean delivery. We searched for randomized controlled trials comparing uterine exteriorization with in situ repair during Cesarean delivery. Primary outcomes were intraoperative nausea and vomiting (IONV) and perioperative decrease in hemoglobin concentration. Secondary outcomes were postoperative nausea and vomiting (PONV), estimated blood loss, fever, endometritis, wound infection, intraoperative and postoperative pain, postoperative analgesic use, duration of surgery and hospital stay, and time to return of bowel function. Twenty studies with 20,909 parturients were included. Exteriorization was associated with higher risk of IONV (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.66 to 2.63; I2 = 0%), with no difference in perioperative hemoglobin concentration decrease (mean difference, -0.06 g·dL-1; 95% CI, -0.20 to 0.08; I2 = 97%) compared with in situ repair. There were no significant differences in estimated blood loss, transfusion requirement, PONV, duration of surgery, duration of hospital stay, time to return of bowel function, fever, endometritis, or wound infection. Postoperative pain (incidence of pain graded > 5/10) at six hours (OR, 1.64; 95% CI, 1.31 to 2.03; I2 = 0%) was higher with exteriorization, but there was no difference in need for rescue analgesia (OR, 2.48; 95% CI, 0.89 to 6.90; I2 = 94%) or pain scores at 24 hr compared with in situ repair. In this updated systematic review and meta-analysis, uterine exteriorization was associated with an increased risk of IONV but no significant change in perioperative hemoglobin decrease compared with in situ repair. PROSPERO (CRD42020190074); registered 5 July 2020.

Comparison of remimazolam and propofol in anesthetic management for awake craniotomy: a retrospective study.

A new ultra-short-acting benzodiazepine intravenous anesthetic agent, remimazolam, was launched in Japan in 2020. Anesthesia during awake craniotomy is reportedly being performed safely using remimazolam; however, studies on its efficacy in awake craniotomy have not been conducted. We aimed to compare the efficacy of remimazolam and propofol in awake craniotomy. In this retrospective study, patients who underwent awake craniotomy (n = 36) at our hospital between December 2019 and January 2021 were divided into two groups: the propofol group (P group: n = 21) and the remimazolam group (R group: n = 15). There was no significant difference in the recovery time between the two groups (p = 0.18). The number of patients experiencing nausea was higher in the R group than in the P group (p = 0.02); however, regression analysis revealed that the use of remimazolam contributed to increased intraoperative nausea (odds ratio = 14.4, p = 0.04). No significant differences were observed in the frequency of vomiting and otherintraoperative complications between the two groups. In conclusion, remimazolam has the potential for use as an alternative drug in anesthetic management during awake craniotomy.

Preventing Intraoperative Nausea and Vomiting During Cesarean Delivery under Spinal Anesthesia

Background: Nausea and vomiting are undesirable intraoperative events among women during cesarean delivery under subarachnoid block. Therefore, prophylaxis is recommended. Aims: This study was undertaken to compare the effect of intravenous cyclizine with metoclopramide administered before achieving subarachnoid block. Patients, Materials and Methods: The study was conducted among women booked for elective cesarean section using the subarachnoid technique. This is a prospective, randomized, double-blinded study that compared the effect of single doses of cyclizine, metoclopramide, and placebo in preventing intraoperative nausea and vomiting among the selected patients. We obtained ethical clearance from the Hospital Research and Ethics Committee as well as written informed consent from each patient involved. The inclusion criteria include women aged 18–45 years with term singleton pregnancy scheduled for elective cesarean section, having the American Society of Anesthesiologists (ASA) physical status grades 1 and 2, with no known contraindications to spinal anesthesia, allergy to study drugs or local anesthetic agents. Patients were excluded if they declined, have a history of allergy to metoclopramide or cyclizine, have pregnancy-induced hypertension, hyperemesis gravidarium, motion sickness, gastrointestinal disease or glucose intolerance. One hundred and twenty parturients with ASA status I-II were recruited and assigned to three groups. All medications were administered intravenously: normal saline in Group I, metoclopramide in Group II, and cyclizine in Group III. Data were collected with study pro forma produced for the study. The Statistical Package for the Social Sciences (SPSS) Version 20.0 was used for analysis of the data collected. Results: The incidence of nausea was least in Group III. There were similar findings for retching and vomiting. Conclusion: We, therefore, concluded that cyclizine is superior to metoclopramide in preventing nausea in women undergoing cesarean section under spinal anesthesia.

Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section.

Background and Aims:Phenylephrine is the vasopressor of choice in spinal anaesthesia–induced maternal hypotension. However, it results in reflex bradycardia and decrease in cardiac output (CO), an effect that is perhaps less evident with the use of norepinephrine. We sought to evaluate the effect of phenylephrine and norepinephrine infusion on maternal systolic blood pressure (SBP), heart rate (HR), intraoperative nausea vomiting (IONV) and fatal Apgar scores.Methods:A randomised double-blind study was conducted on 200 American Society of Anesthesiologists (ASA) II–III parturients undergoing caesarean section under subarachnoid block (SAB) who were randomised to two groups A and B to receive variable rate, manually controlled infusions of phenylephrine and norepinephrine targeting maintenance of SBP to 100% of the baseline value. Maternal haemodynamics especially episodes of hypotension, IONV and vasopressor consumption were observed and recorded.Results:A statistically significant trend of lower SBP was observed during the first 6 min following intrathecal injection in group A (P value – 0.000). Though a greater number of parturients experienced ≥1 episode of hypotension in Group A vs Group B (13% vs 9%), the difference was, however, statistically insignificant. The incidence of bradycardia was higher in group A than in group B (16% vs 1%) and was found to be statistically significant (P < 0.05). The episodes of hypertension, IONV, maternal vasopressor consumption and neonatal Apgar score were comparable among both the groups.Conclusion:A dilute solution of norepinephrine infusion is comparably efficacious to the current gold standard vasopressor phenylephrine in maintaining blood pressure following spinal anaesthesia for caesarean delivery, with a significantly lower incidence of bradycardia.

Acupressure and Acupuncture Use in the Peripartum Period.

Acupuncture is the procedure of inserting fine needles into specific points on the body for therapeutic purposes. Acupuncture and its derivatives (acupressure, moxibustion, electroacupuncture, and transcutaneous electric nerve stimulation on acupoints) are a popular treatment choice in the peripartum period (32 wk' gestation to 14 d postdelivery). There is substantial research evidence supporting acupuncture and its derivatives in the peripartum period. Benefits in the use of acupressure to reduce labor pain intensity and a reduction in the duration of labor with acupressure have been found. There is mixed evidence for the use of both moxibustion and moxibustion with acupuncture for noncephalic presentations and for acupressure for reducing intraoperative nausea. There is limited evidence available on acupuncture use in women with high-risk pregnancies or multifetal gestations.

Effect of continuous infusion of a subhypnotic dose of propofol on nausea and vomiting after carboprost administration at cesarean delivery: A randomized, double-blind, placebo-controlled trial.

To investigate whether continuous infusion of propofol at a subhypnotic dose prevents nausea and vomiting following carboprost administration at cesarean delivery. A prospective, randomized, double-blind, placebo-controlled trial conducted at West China Second University Hospital, from June 28, 2017 to January 30, 2018. Pregnant women were randomly allocated to propofol or saline infusion immediately before receiving carboprost at cesarean delivery under combined spinal-epidural (CSE) anesthesia. Propofol was given at an infusion rate of 1.0mg/kg/h following a loading dose of 0.3mg/kg. Primary outcome was incidence of intraoperative nausea and vomiting (IONV). Potential sedative effect of propofol infusion was assessed using Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scoring and continuous Bispectral Index (BIS) monitoring. The incidence of IONV was lower in patients who received propofol compared with saline (46.7% vs 76.7%, OR 0.27; 95% CI, 0.092-0.78, P=0.016 for nausea; 26.7% vs 53.3%, OR 0.50; 95% CI, 0.25-0.95, P=0.032 for retching; 10.0% vs 50.0%, OR 0.11; 95% CI, 0.03-0.44, P<0.001 for vomiting). There were no differences in MOAA/S scoring or BIS between the two groups. A subhypnotic dose of propofol reduces the incidence of nausea and vomiting following carboprost administration at cesarean delivery under CSE anesthesia, without measurable effect on patients' consciousness or alertness. ClincalTrials.gov: NCT03185156.

Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section.

Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section.

Magnitude and associated factors of intraoperative nausea and vomiting among parturients who gave birth with cesarean section under spinal anesthesia at South Gondar zone Hospitals, Ethiopia

BackgroundIntraoperative nausea and vomiting are common intraoperative events by which parturient feel discomfort and disturbed after spinal anesthesia. MethodsHospital-based cross-sectional study was conducted on mothers who underwent cesarean section with spinal anesthesia. Descriptive analysis and chi-square test were employed. Bivariable and multivariable logistic regressions were used to measure the association of factors with the outcome variable intraoperative nausea and vomiting. A p-value of ≤0.05 was used to decide statistical significance for multivariable logistic regression. ResultA total of 246 parturients were participated in this study. The incidence of intraoperative nausea and vomiting was 40.2%. According to multivariable logistic regression, age greater than 30 years (AOR, 6.26; 95%CI, 2.2–17.78; p-value 0.001), primiparous (AOR, 3.72; 95%CI, 1.35–10.24; p-value, 0.011), having motion sickness (AOR, 7.1; 95%CI, 2.75–18.33; p-value 0.001), emergency cesarean sectin (AOR, 9.85; 95%CI, 3.19–30.38; p-value 0.001), oxygen suplimentation (AOR, 0.021; 95%CI, 0.005–0.08; p-value 0.0001) and uterotonic agent (AOR, 2.99; 95%CI 1.24–7.22; p-value 0.015) had statistically significant association with intraoperative nausea and vomiting. ConclusionIn our study, the overall incidence of intraoperative nausea and vomiting after spinal anesthesia was 40.2%. Parturients with age greater than 30 years, having motion sickness, didn't get intraoperative supplemental oxygen, oxytocin used for the uterotonic purpose, emergency surgery, and primiparous were at increased risk of intraoperative nausea and vomiting.

A Comparative Study on Effect of Low Dose Ketamine versus Dexamethasone on Intraoperative Nausea and Vomiting during Cesarean Section under Spinal Anesthesia

A Comparative Study on Effect of Low Dose Ketamine versus Dexamethasone on Intraoperative Nausea and Vomiting during Cesarean Section under Spinal Anesthesia