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

2021 ◽  
Vol 11 (1) ◽  
pp. 110
Author(s):  
Zhirajr Mokini ◽  
Valentina Genocchio ◽  
Patrice Forget ◽  
Flavia Petrini
Keyword(s):  
Risk Factor ◽  
Cesarean Section ◽  
Control Strategy ◽  
Nausea And Vomiting ◽  
Medium Effect ◽  
Risk Factor Control ◽  
Double Blind ◽  
Cord Clamping ◽  
Umbilical Cord Clamping ◽  
And Control

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.

Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Demographic Data ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Group A ◽  
Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

scholarly journals CONTROL OF POST-SURGICAL PAIN

2010 ◽  
Vol 17 (03) ◽  
pp. 400-404
Author(s):  
ALI MIR MANSOURI ◽  
FARNOUSH FARZI ◽  
SHIRIN KHALKHALIRAD ◽  
Katayoon Haryalchi ◽  
Abas Sediginejad
Keyword(s):  
Pain Relief ◽  
Cesarean Section ◽  
Pain Control ◽  
Nausea And Vomiting ◽  
Chi Square ◽  
Double Blind ◽  
Analgesic Effects ◽  
Emergency Cesarean ◽  
Surgical Pain ◽  
Chi Square Test

Introduction: There are many complications for patients with post cesarean section relative pain. So it delays in discharging or increasing in hospital stay. The objective of this study was a comparison between Tramadol and Meperidine according to pain relief or other possible complications in post cesarean section pain control. Materials and Methods: This study was a double blind clinical trial. It arranged for 240 parturients who scheduled for emergency cesarean section with pain after surgery in spite of spinal anesthesia. All patients were in ASA class I. They were divided randomly in two groups .Meperidine (M) and Tramadol (T) groups with 120 patients in each group. After beginning of pain in post anesthesia care unit (VAS> or = 4), in group (T) tramadol 1.5 mg/kg and in group (M) meperidine  .5 mg/kg were injected intravenously. Apart from pain, other drug complications such as shivering, blood pressure changes, itching, nausea and vomiting, drowsiness were recorded one and two hours after injection. Data were analyzed by chi-square test. Results: Relative frequency rate (RFR) of 50% decrease in pain score one hour after intravenous injection was 56.7% in group (T) and 69.2% in group (M) ( P = 0.054). RFR for respiratory depression after one hour was 5.8% in (M) group and 0 in (T) group (P = 0.007). RFR for nausea after one hour was 39.2% in (T) group and 23.3% in (M) group (P = 0.008). RFR for vomiting after one hour was 23.3% in (T) group and 13.3% in (M) group (P= 0.045). RFR for drowsiness after one hour was 25% in (M) group and 3.3% in (T) group (P=0.007). There was no statistically significant relationship after 2nd hour for pain relief, nausea, vomiting and drowsiness between two groups. There was no difference between two groups in RFR for shivering, blood pressurechanges and itching in both two groups. Conclusion: This study illustrates both remedies Meperidine and Tramadol which were effective for pain relief and shivering after cesarean section. But according to high incidence of nausea and vomiting with Tramadol and more analgesic effects of Meperidine than Tramadol, administration of Meperidine is better than Tramadol after cesarean section for pain control.

scholarly journals Oxytocin 10 IU as Prophylactic for Uterine Atony : a Randomized Clinical Trial

2019 ◽  
pp. 170-178
Author(s):  
Ridwan A Putra ◽  
Iskandar Zulqarnain ◽  
Zaimursyaf Azis ◽  
Jusuf S Effendi ◽  
Wiryawan Permadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Risk Factor ◽  
Side Effects ◽  
Cesarean Section ◽  
Randomized Clinical Trial ◽  
Uterine Atony ◽  
Transverse Incision ◽  
Double Blind ◽  
Emergency Cesarean

Abstract Objective : To compare the effectiveness of oxytocin dose of 10 IU and 20 IU for preventing uterine atony in women undergoing cesarean section. Methods : This was a double-blind, randomized clinical trial with good matching selection with randomization block of patients who had risk factors for the occurrence of uterine atony such as preeclampsia, patients were receiving MgSO4, oxytocin intrapartum and chorioamnionitis who performed stratified randomization prospectively with two kinds of oxytocin doses which are 10 IU and 20 IU as a prophylaxis for uterine atony in women who performed emergency cesarean section with transverse incision and were using a general anesthesia. Results : This study found no any significant differences between the use of 10 IU and 20 IU as prophylaxis for uterine atony during cesarean section either in its action at the time or while in recovery room, especially on the cases without chorioamnionitis thus using oxytocin 10 IU regimen can be considered, besides the effectiveness did no differ, it will cost cheaper than oxytocin 20 IU regimen which frequently used. Conclusions : There were no significant differences in the incidence of blood loss during the cesarean section between the treatment of oxytocin 10 IU group and oxytocin 20 IU group. The additional uterotonic was using during the action of the cesarean section between the treatment of oxytocin 10 IU group, and oxytocin 20 IU group gave no significant differences. The side effects in this study at least form of chills and vomiting found no significant differences between both of groups despite the side effects that arise in oxytocin 20 IU group was higher at 23.08% than oxytocin 10 IU group at 15.19%. Chorioamnionitis would be a risk factor for the occurrence of uterine atony during the action of the cesarean section if it associated with the use of additional uterotonic in oxytocin 10 IU group if compared with oxytocin 20 IU group. Keywords : cesarean section, oxytocin, uterine atony.   Abstrak Tujuan : Untuk membandingkan efektifitas penggunaan dosis 10 IU dan 20 IU sebagai profilaksis atonia uteri pada saat seksio sesarea. Metode : Penelitian ini menggunakan uji klinis acak ganda dengan seleksi yang sesuai dengan blok acak pada pasien-pasien yang memiliki faktor risiko terjadinya atonia uteri seperti preeklamsia, pasien yang diberikana MgSO4 dan oxytocin intrapartum sebelumnya serta chorioamnionitis yang dilakukan pengacakan secara prosfektif bertingkat yang diberikan dua jenis dosis oksitosin yaitu 10 IU dan 20 IU sebagai profilaksis atonia uteri pada perempuan yang dilakukan seksio sesarea darurat dengan insisi transversal dan menggunakan anestesi umum. Hasil : Penelitian ini menemukan tidak adanya perbedaan yang bermakna antara penggunaan dosis oksitosin 10 IU dan 20 IU sebagai profilaksis atonia uteri pada seksio sesarea baik saat tindakan operasi maupun saat berada di ruang pemulihan, terutama pada kasus-kasus tanpa khorioamnionitis dimana memerlukan oksitosin tambahan pada kelompok 10 IU, selain efektifitasnya tidak berbeda, akan lebih murah dari pada rejimen oksitosin 20 IU yang sering digunakan saat ini. Kesimpulan : Berdasarkan hasil penelitian ini, tidak ada perbedaan yang bermakna dalam kejadian kehilangan darah selama operasi seksio sesarea antara perlakuan kelompok oksitosin 10 IU dan kelompok oksitosin 20 IU. Penggunaan uterotonik tambahan selama tindakan seksio sesarea antara perlakuan kelompok oksitosin 10 IU dan kelompok oksitosin 20 IU tidak memberikan perbedaan yang signifikan. Efek samping dalam penelitian ini yakni menggigil dan muntah, tidak ditemukan perbedaan yang bermakna antara kedua kelompok meskipun efek samping yang muncul pada kelompok oksitosin 20 IU lebih tinggi 23,08% dibandingkan kelompok oksitosin 10 IU pada 15,19%. Khorioamnionitis merupakan faktor risiko terjadinya atonia uteri selama tindakan seksio sesarea jika dikaitkan dengan penggunaan uterotonika tambahan pada kelompok oksitosin 10 IU jika dibandingkan dengan kelompok oksitosin 20 IU. Kata kunci : atonia uteri, oksitosin, seksio sesarea.

scholarly journals The Type of Anesthesia Used during Cesarean Section Is Related to the Transient Tachypnea of the Newborn

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Esengül Keleş ◽  
Hamza Yazgan ◽  
Arzu Gebeşçe ◽  
Emine Pakır
Keyword(s):  
Cesarean Section ◽  
Quantitative Difference ◽  
International Classification Of Diseases ◽  
Skin Incision ◽  
Spinal Block ◽  
Time Interval ◽  
Cord Clamping ◽  
Classification Of Diseases ◽  
Umbilical Cord Clamping ◽  
Spectrum Of Patients

Aim. To demonstrate whether transient tachypnea of the newborn (TTN) is found more frequently in women undergoing general or combined epidural-spinal (CES) anesthesia during Cesarean section. Methods. This study was done retrospectively. A total of 1447 Cesarean sections (C/S) were performed in our clinic between January 2008 and December 2011. General anesthesia was performed in 1078 (74.5%) of the Cesarean cases. CES anesthesia was performed in 369 cases (25.5%). The International Classification of Diseases,Tenth Revision code of P22.1, was used to identify the infants with TTN. Stratified multivariate analysis was undertaken on subgroups to assess the effect modification by factors known to influence the incidence of TTN: maternal age, maternal systolic-diastolic artery pressure, heart rate, Apgar score at 1 and 5 minutes, sex, time interval from spinal block to skin incision, and time interval from skin incision to umbilical cord clamping. Results. The rate of TTN diagnosis was found to be higher in parturients who had a cesarean section with combined epidural-spinal anesthesia, but no statistical differences were found. (P<0.05) (odds ratio = 1.471 and 95%CI: 0.92–2.35). Conclusions. The incidence of TTN was found related to C/S but independent from the type of anesthesia. However, studies with a wider spectrum of patients and a lower quantitative difference between the groups are needed in order to draw firm this conclusions.

scholarly journals Comparison of Short Vs. Long Half-Life Single-Dose Prophylactic Antibiotics for Cesarean Section

1994 ◽  
Vol 2 (3) ◽  
pp. 120-125 ◽  
Author(s):  
Bernard Gonik ◽  
James McGregor
Keyword(s):  
Single Dose ◽  
Cesarean Section ◽  
Half Life ◽  
Study Groups ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Prophylactic Efficacy ◽  
Cord Clamping ◽  
Containment Measures ◽  
Elective Cesarean

Objective:Numerous studies demonstrate the efficacy of antibiotic prophylaxis for reducing postcesarean section infectious morbidity. The duration of therapy, however, remains controversial. Cost containment measures and the ease of single dosing have led to the introduction of “extended” half-life agents for cesarean-section chemoprophylaxis. We tested the hypothesis that there was no difference in efficacy between a single dose of a short half-life agent (cefoxitin) and a longer half-life agent (cefotetan).Methods:A prospective, double-blind trial of 375 non-elective cesarean-section cases was carried out. Study antibiotics (2 g) were administered intravenously (IV) at cord clamping only.Results:Demographic and clinical variables between the 2 study groups were similar. No significant differences were noted in major or minor morbidity or in infectious morbidities for patients receiving the 2 prophylactic regimens. The occurrence of postoperative endometritis was likewise similar for the subjects receiving cefoxitin (10%) and cefotetan (15%). When cases whose surgery lasted >60 min were evaluated separately, no differences in outcomes between the 2 groups were identifiedConclusions:These findings confirm our hypothesis that the half-life difference between these 2 agents does not impact on single-dose Prophylactic efficacy in cesarean section.

scholarly journals Acculturation and Cardiovascular Risk Factor Control among Hispanic Adults in the United States

2009 ◽  
Vol 124 (6) ◽  
pp. 818-824 ◽  
Author(s):  
Pracha P. Eamranond ◽  
Christina C. Wee ◽  
Anna T.R. Legedza ◽  
Edward R. Marcantonio ◽  
Suzanne G. Leveille
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Hemoglobin A1c ◽  
Ldl Cholesterol ◽  
Risk Factor Control ◽  
Hispanic Adults ◽  
Cholesterol Control ◽  
And Control

Objectives. We sought to determine whether low acculturation, based on language measures, leads to disparities in cardiovascular risk factor control in U.S. Hispanic adults. Methods. We studied 4,729 Hispanic adults aged 18 to 85 years from the National Health and Nutrition Examination Survey, 1999–2004. We examined the association between acculturation and control of low-density lipoprotein (LDL) cholesterol, blood pressure, and hemoglobin A1c based on national guidelines among participants with hypercholesterolemia, hypertension, and diabetes, respectively. We used weighted logistic regression adjusting for age, gender, and education. We then examined health insurance, having a usual source of care, body mass index, fat intake, and leisure-time physical activity as potential mediators. Results. Among participants with hypercholesterolemia, Hispanic adults with low acculturation were significantly more likely to have poorly controlled LDL cholesterol than Hispanic adults with high acculturation after multivariable adjustment (odds ratio [OR] = 3.4, 95% confidence interval [CI] 1.2, 9.5). Insurance status mildly attenuated the difference in LDL cholesterol control. After adjusting for diet and physical activity, the magnitude of the association increased. Other covariates had little influence on the observed relationship. Among those with diabetes and hypertension, we did not observe statistically significant associations between low acculturation and control of hemoglobin A1c (OR=0.5, 95% CI 0.2, 1.2), and blood pressure (OR=1.1, 95% CI 0.6, 1.7), respectively. Conclusions. Low levels of acculturation may be associated with increased risk of inadequate LDL cholesterol control among Hispanic adults with hypercholesterolemia. Further studies should examine the mechanisms by which low acculturation might adversely impact lipid control among Hispanic adults in the U.S.

scholarly journals Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Rami Sommerstein ◽  
◽  
Jonas Marschall ◽  
Andrew Atkinson ◽  
Daniel Surbek ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Umbilical Cord ◽  
Multilevel Models ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
World Health ◽  
Cord Clamping ◽  
Umbilical Cord Clamping ◽  
Health Organization

Abstract Background The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. Methods Study design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. Results SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96–1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results. Conclusions This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.

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