Randomized Controlled Trial of Prophylactic Subhypnotic Propofol vs Metoclopramide and in Combination Therapy for the Prevention of Nausea and Vomiting During Subarachnoid Anesthesia for Cesarean Section.
Randomized Controlled Trial of Prophylactic Subhypnotic Propofol vs Metoclopramide and in Combination Therapy for the Prevention of Nausea and Vomiting During Subarachnoid Anesthesia for Cesarean Section.
Perioperative nausea and vomiting may occur in 50-80% of patients undergoing cesarean section.
Metoclopramide is a well known Dopamine receptor antagonist that acts at the Chemoreceptor trigger zone and is used effectively for the prevention and treatment of nausea and vomiting. Propofol can antagonize Serotonin receptors in the area postremal and is associated to a reduced incidence of postoperative nausea and vomiting. Some studies have shown that propofol can prevent intraoperative nausea and vomiting during cesarean section.
The control of risk factors and the pharmacological prophylaxis of nausea and vomiting reduces effectively their incidence.
In this randomized, double blind, case-control study the efficacy of propofol alone, metoclopramide alone and in combination in controlling nausea and vomiting were compared. A risk factor control strategy was associated to each study group.
Inclusion Criteria:
CESAREAN SECTION WITHOUT MATERNAL OR FETAL SUFFERING
American Society of Anesthesiologists score I-II
36 TO 41 WEEK OF GESTATION
BMI < 35
HEMOGLOBIN > 10 mg/dl
NO COMPLICATIONS (GESTATIONAL DIABETES, COLESTASIS)
NO ACUTE OR CHRONIC GASTROINTESTINAL DISORDERS (GERD excluded)
NO SMOKING OR DRUG ABUSE DURING PREGNANCY
NO PREVIOUS MAJOR ABDOMINAL SURGERY
NO PREVIOUS COMPLICATED PREGNANCIES
FETAL WEIGHT > 2.5 kg
Exclusion Criteria:
EMERGENCY CESAREAN SECTION WITH MATERNAL OR FETAL SUFFERING
American Society of Anesthesiologists score III-IV-V
< 36 OR > 41 WEEK OF GESTATION
BMI > 35
HEMOGLOBIN < 10 mg/dl
COMPLICATIONS (GESTATIONAL DIABETES, COLESTASIS)
ACUTE OR CHRONIC GASTROINTESTINAL DISORDERS
SMOKING OR DRUG ABUSE DURING PREGNANCY
PREVIOUS MAJOR ABDOMINAL SURGERY
PREVIOUS COMPLICATED PREGNANCIES
FETAL WEIGHT < 2.5 kg