Effect of SubhypnoticDosesof Propofol and Midazolam for Nausea and Vomiting DuringSpinal Anesthesia for Caesarean Section

Abstract

Background:Spinal anesthesia has been associated with intraoperative nausea and vomiting (IONV), especially during cesarean section, which is attributed to several mechanisms.Objectives:In the present study, therapeutic and preventive properties of sub hypnotic dose midazolam and propofol and their effects on the occurrence and severity of intraoperative nausea and vomiting during elective cesarean section under spinal anesthesia were evaluated.Patients and Methods:In a randomized, double-blind, and placebo-controlled clinical trial, 90 parturients, ASA class I and II, aged 20-30 years, who undergone spinal anesthesia for cesarean section were randomly allocated to one of three groups receiving midazolam (1 mg bolus and 0.1 mg/kg/hr, n=30), propofol (20 mg bolus and 0.1 mg/kg/hr, n = 30), and placebo (saline, n=30) intravenously (IV) immediately after umbilical cord clamping. Bupivacaine hydrochloride (10 mg) was used for induction of the anesthesia. Patients’ hemodynamics was monitored at 3-minute intervals. Furthermore, intraoperative and post-delivery emetic episodes, severity of emesis, scores of sedation and ephedrine consumption were recorded.Results:The incidence of nausea, retching, and vomiting was significantly higher in the control group compared to propofol and midazolam groups. Overall, PONV (postoperative nausea and vomiting) in midazolam group was as low as propofol group without any significant hemodynamic changes as seen in placebo group or even with propofol group.Conclusions:Subhypnotic doses of midazolam or propofol are effective in the prevention of nausea and vomiting during and after cesarean section with spinal anesthesia and does not significantly influence hemodynamic of the patients.

Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

“…35 In contrast, Rasooli et al found that subhypnotic doses of both agents effectively prevent peri-and postoperative nausea and vomiting in patients underwent C/S after SA. 36 Likewise, we found lower nausea and vomiting incidences in parturients during C/S, but this time by using IV thiopental.…”

The Effects of Acupuncture on Nausea and Vomiting and Consumption of Propofol in Cesarean Section Performed With Spinal Anesthesia

“…Hypotension observation rates and associated nausea and vomiting are common in cesarean section performed under spinal anesthesia (4,19). In a study conducted by Voigt et al (20), the incidence of hypotension in cesarean was identified as 46.2%.…”

“…Intra-operative nausea and vomiting rate was observed as 46.15% in the same study. The most commonly used method for the treatment of nausea and vomiting observed due to hypotension formed by the effects of spinal anesthesia is the use of vasopressor medications, especially the use of ephedrine in order to prevent hypotension (7,19). Considering the side effects of ephedrine used for the treatment of hypotension that occurs after spinal anesthesia in caesarean operations performed under spinal anesthesia, studies have been conducted to identify different doses of ephedrine or new drugs and techniques that can be used instead of ephedrine (4,5,16,21).…”

Influences of Different Doses of Midazolam on Mother and Fetus in Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome

“…Its hypnotic effect is also positively correlated with dose, so an increased dose may increase the risk of obstruction in the upper respiratory tract due to glossocoma. Since the specific condition of pregnant woman may more easily result in respiratory complications such as glossoco- 154 ma, a dose of less than 0.05 mg/kg is recommended for pregnant women [27] . In this study, the doses of midazolam were relatively low in both the groups, the changes in RR and SpO2 were not marked.…”