Prophylactic antiemetic effects in gynecologic patients receiving fentanyl IV-patient controlled analgesia: comparison of combined treatment with ondansetron and dexamethasone with metoclopramide and dexamethasone / 대한마취과학회지

BACKGROUND: This study was conducted to compare the efficacy of a combination of ondansetron and dexamethasone with that of metoclopramide and dexamethasone for prevention of postoperative nausea and vomiting (PONV) in gynecologic patients receiving fentanyl IV-patient controlled analgesia. METHODS: One hundred patients were divided into two groups at random. In Group O, 5 mg of dexamethsone was administered after tracheal intubation, while 4 mg of ondansetron was administered at the end of surgery. In Group M, 5 mg of dexamethsone was administered after tracheal intubation and 20 mg metoclopromide was administered at the end of surgery. During the experiment, the PONV was evaluated at regular intervals. In addition, the incidence of nausea, and vomiting and the numerical rating scale (NRS) of nausea was measured (range, 0-10). RESULTS: The overall incidence of PONV in Group O was 22/50 (44%) while that in Group M was 19/50 (38%). There were no significant differences in the incidence of nausea, moderate to severe nausea (NRS of nausea, 4-10), or vomiting between groups. CONCLUSIONS: Treatment with a combination of 20 mg metoclopramide and 5 mg dexamethasone is an effective, safe, and inexpensive way to prevent PONV when compared to treatment with 4 mg ondansetron and 5 mg dexamethasone.

Comparison of maternal and fetal effects of ephedrine, phenylephrine, and combination infusion during spinal anesthesia for cesarean delivery

BACKGROUND: Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal and neonatal effects. Single treatment with ephedrine does not prevent spinal anesthesiainduced hypotension and phenylephrine alone induces severe bradycardia. However, the combined treatment of phenylephrine with ephedrine as an infusion was observed to be effective without bradycardia. METHODS: Thirty-two term parturients were randomized into three groups to receive ephedrine, phenylephrine or combination infusion (group E, group P and group EP, respectively) starting with spinal anesthesia. Hemodynamic parameters, such as SBP, PR, CI, SVRI, SVI, were measured before and until 15 min after spinal anesthesia. Rescue boluses for hypotension comprised of phenylephrine 100microg. RESULTS: There were no statistically significant differences in all hemodynamic parameters among three groups. However, 1 min Apgar score in the group E was significant lower than P group (P = 0.008). Nausea & vomiting scores, total fluid intake, phenylephrine rescues, umbilical vein pH, and 5 min Apgar scores did not show significant differences. CONCLUSIONS: Three methods are all effective to prevent hypotension following spinal anesthesia for cesarean section. However, although there was no fetal acidosis, 1 min Apgar score of ephedrine group was significantly lower than that of phenylephrine alone group.