Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia

Sane, Shahryar; Hasanlui, Mohammadamin Valizadeh; Abbasivash, Rahman; Mahoori, Alireza; Hashemi, Seyed Taghi; Rafiei, Fahime

doi:10.4103/2277-9175.167030

Cited by 16 publications

(10 citation statements)

References 33 publications

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“…They showed that intraoperative nausea was higher among patients treated with dexamethasone and lesser in patients who received their combination. But PONV was similar between the groups (23). Although the antiemetic effects of dexamethasone are well shown, the underlying mechanism of it is largely unknown (14).…”

Section: Discussionmentioning

confidence: 90%

Antiemetic effects of metoclopramide with and without dexamethasone in children with minor head trauma: a single blind randomized clinical trial

Moezzi¹,

Delirrooyfard²,

Motamed³

et al. 2018

Electron. physician

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Background: Trauma in the head is one of the most common childhood injuries. Children with minor head trauma are at higher risk of intracranial injury (ICI). Vomiting is one of the most common signs after minor head trauma in children, and different treatments are suggested for managing it. Objective: To determine the antiemetic effects of dexamethasone in children with minor head trauma. Methods: This single blind randomized clinical trial study was carried out during the period from September 2015 to August 2016 in Imam Khomeini and Golestan Hospitals in Ahvaz, Iran, on 64 children (2-8 years old) with minor head trauma (Minor head trauma was considered as GCS 14-15) who were admitted to the hospitals' emergency departments. In the intervention group, metoclopramide (0.15 mg/kg) and dexamethasone (0.15 mg/kg) were injected. In the placebo group, patients received metoclopramide (0.15 mg/kg) and placebo. Nausea severity was measured using Rhodes Index of Nausea and Vomiting. The data were analyzed using SPSS version 19. We used descriptive statistics, Chi-squared, t-test, and ANOVA for the analyses of the data. P-value of less than 0.05 was defined as the level of significance. Results: Finally, 62 patients (mean age of 56.4 and 62% male gender) attended the study and were equally divided into intervention and placebo groups. The Rhodes Index of Nausea and Vomiting on the intervention and placebo groups was 4.9±3.73 and 7.19±3.79, respectively (p=0.021). Conclusion: Collectively, our results indicated that dexamethasone can be used as an effective medication along with metoclopramide to control vomiting in children with minor head trauma. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016081128944N1.

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Section: Discussionmentioning

confidence: 90%

Antiemetic effects of metoclopramide with and without dexamethasone in children with minor head trauma: a single blind randomized clinical trial

Moezzi¹,

Delirrooyfard²,

Motamed³

et al. 2018

Electron. physician

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“…The guidelines for PONV have been updated based on many clinical studies [ 5 , 6 ]. 5-HT 3 receptor antagonists, including ondansetron, are the gold standard antiemetics [ 7 , 8 ], and NK-1 receptor antagonists are also reported to be as effective as 5-HT 3 receptor antagonists [ 9 , 10 ]. However, 5-HT 3 and NK-1 receptor antagonists have not been approved for routine use by the Japanese Ministry of Health, Labor and Welfare as part of the public medical insurance coverage for perioperative antiemetics due to high cost.…”

Section: Resultsmentioning

confidence: 99%

Effect of Goreisan, a traditional Japanese Kampo medicine, on postoperative nausea and vomiting in gynecological patients

2017

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BackgroundGoreisan, a traditional Japanese Kampo medicine, may prevent postoperative nausea and vomiting (PONV). The purpose of this study was to evaluate the effect of Goreisan on PONV in a high-risk population in a randomized, double-blind, placebo-controlled manner.FindingsPatients undergoing gynecological surgery were randomly allocated to the Goreisan and the control groups. General anesthesia was induced with propofol and remifentanil. After endotracheal intubation, anesthesia was maintained with sevoflurane, fentanyl, and remifentanil. Goreisan 7.5 g dissolved in water (Goreisan group) or water (control group) in a volume of 20 ml was administered through a nasogastric tube approximately 1 h before completion of surgery. The primary outcome of this study was the incidence of PONV during the first 2 h after extubation. In the interim analysis, it was apparent that Goreisan has no effect. Therefore, we discontinued recruiting patients and present results based on data from 83 patients. The incidence of PONV during the first 2 h after extubation was 45% in the Goreisan group (n = 40) and 46.5% in the control group (n = 43) (p = 0.89). There was no significant difference in PONV incidence or severity during the first 24 h post-extubation.ConclusionGoreisan has little potency in preventing PONV in high-risk patients.

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“… 34 , 35 Drugs from different classes seem to complement each other concerning their antiemetic effects. 36 …”

Section: Discussion: Current Guidelines and Literaturementioning

confidence: 99%

“… 41 However, it may be considered for combination prophylaxis in conjunction with another drug with a different receptor profile. 40 Sane et al 36 published results of a randomized, prospective, double-blinded study in 2015. The trialists included 90 parturients undergoing elective CS with SPA and investigated the effectiveness of ondansetron 4 mg or dexamethasone 8 mg or a combination of both drugs.…”

Section: Discussion: Current Guidelines and Literaturementioning

confidence: 99%

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

Jelting

Klein

Harlander

et al. 2017

LRA

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BackgroundIntraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids.MethodsGiven the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts.Discussion and conclusionTaking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal–epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

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Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia

Cited by 16 publications

References 33 publications

Antiemetic effects of metoclopramide with and without dexamethasone in children with minor head trauma: a single blind randomized clinical trial

Antiemetic effects of metoclopramide with and without dexamethasone in children with minor head trauma: a single blind randomized clinical trial

Effect of Goreisan, a traditional Japanese Kampo medicine, on postoperative nausea and vomiting in gynecological patients

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

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