[ comparison between ondansetron and metoclopramide in preventing postoperative nausea and vomiting]

Antiemetics currently in use are not totally effective. Serotonin Receptor Antagonists are a new class of antiemetics that have shown promise for the treatment of nausea and vomiting in many situations. This study aims at evaluating the efficacy of Serotonin Receptor Antagonist, Ondansetron, for the prevention of postoperative nausea and vomiting. This randomized, double-blind study compared the efficacy of an intravenous dose of Ondansetron 4 mg. with Metoclopramide 10mg. for the prevention of postoperative nausea and vomiting [PONV] in patients undergoing general anesthesia for open abdominal surgery. A total of 126 patients [63 Ondansetron group, 63 Metoclopramide group], ASA status I-II, aged 18-65 years, were included and received the study medication after the induction of anaesthesia. A standardized anesthetic technique and intraoperative analgesia were used for all the patients. Within a period of 24 hours after the surgery, the following data were gathered and recorded: the proportion of the patients experiencing no emesis or no nausea as well as those who were provided with rescue antiemetic medication, the duration of nausea and the number of emetic episodes. During the overall observation period [i.e. 0-24 hours], more patients who had received Ondansetron had significantly no emetic episodes [87.3%] than those who had received Metoclopramid [73%, P=0.044]. A higher proportion of patients receiving Ondansetron [71.4%] did not experience nausea [Metoclopramide 63.5%, P=0.342]. Fewer patients in the Ondansetron group required rescue medication [P<0.05]. Ondansetron was superior to Metoclopramide for the prevention of vomiting in the first 24 hours after surgery and the total number of emetic episodes was significantly reduced, as compared with Metoclopramide, but no significant differences were observed between Ondansetron and Metoclopramide for either the prevention of nausea or the treatment failure

[Vaginal birth after cesarean sections]

It is believed that vaginal delivery is associated with less maternal mortality than cesarean section. On the other hand, repeated cesarean sections are said to be associated with more risks threatening both the mother and the infant. Besides, it is believed that during the next pregnancies, there are many risks involved, such as Placenta Previa, Placenta acreta and even hysterectomy. This article is about a woman who experienced successful vaginal deliveries giving birth to healthy newborns in spite of her numerous cesarean sections she had already experienced

[Studying some of the hemodynamic effects of adding epinephrine to lidocaine for spinal Anesthesia]

Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties [e.g. difficult intubations, aspiration pneumonia, and analgesic side effect] in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine's Alfa adrenergic is dominant. This study aimed at investigating the potential hemodynamic effects of adding Epinephrine to lidocaine during spinal anesthesia on expecting mothers who are candidates of caesarean section. This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387. The subjects of the study were divided into two groups, [1] and [2] on the basis of the randomized digital table as follows: Group 1:80 mg lidocaine 5% +2 micro gram sufentanil Group2: 80 mg lidocaine 5% +2 micro gram sufentanyl + 0.2 mg [0.2cc] Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded. According to the findings in this study, there weren't any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There weren't any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there weren't any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There weren't any significant differences in SPO2 and side effects [nausea, vomiting, dysphagia, respiratory disorder, shivering] between the two groups. Adding Epinephrine to Lidocaine 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of hemodynamic and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of hemodynamic in this group is essential