Abstract:Objectives: Some earlier studies has highlighted the analgesic potentiating effects of intrathecal fentanyl hydrochloride while some recent studies have focused on the effects of decreasing post operative nausea and vomiting . Hence, the current study was planned on comparing the effects of intrathecal fentanyl and intravenous ondansetron in reducing the perioperative nausea and vomiting. Materials and methods: In this randomized prospective study, 140 patients (ASA I&II, aged 18-35 years ) undergoing elective caesarean section were divided into two equal groups (n=70) to receive either intrathecal 20 microgram (0.4ml) with 2.2 ml bupivacaine 0.5% heavy plus 2 ml normal saline intravenously (Group F) or 0.4 ml of normal saline with equal amount of bupivacaine 0.5 % heavy plus 4 mg (2 ml) of ondansetron intravenously (Group O) to compare their effects on perioperative nausea and vomiting . Results: The incidences of intraoperative nausea (12.8% vs 7.15%), vomiting (8.58% vs 4.28%) and retching (8.58% vs 4.28%) were higher in the ondansetron group compared with the fentanyl group and statistically not significant(nausea , P=0.26;vomiting ,P=0.30 and retching , P=0.30). However, the incidence of postoperative nausea , vomiting and retching were higher in the fentanyl group (7.15% vs 2. 86%,P=0.25; 4.28vs2.86,P=0.65 and 4.28vs2.86,P=0.65) respectively. Intraoperative and postoperative hemodynamic parameters were comparable in the two groups(P>0.05). Conclusion:Although not statistically significant , the incidences of nausea , vomiting and retching were higher in the ondansetron group intraopertively and the same being higher in the fentanyl group postopertively.

A 20 years old ASA I full term primigravida in labor, underwent an emergency lower segment cesarean section under spinal anesthesia, the indication being fetal distress. Immediately following delivery of fetus, she complained of severe breathlessness and suffered a cardiovascular collapse. A presumptive diagnosis of high spinal anesthesia was made and she was managed accordingly. Thirty minutes later she developed angioedema which increased in severity over the next two hours and a diagnosis of anaphylactic reaction was made. The patient responded to intravenous adrenaline and recovered over next 24 hours. The aim of this case report is to discuss cardiovascular collapse and its etiological factors, such as anaphylaxis, amniotic fluid embolism and high spinal anesthesia during cesarean section.