RESUMO
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common adverse effect of intrathecal morphine, especially after Cesarean section. This randomized controlled trial investigated the effects of intrathecal administration of a small-dose of atropine on postoperative nausea and vomiting after Cesarean section. METHODS: Parturients with ASA physical status class I-II scheduled for elective Cesarean section and consenting to spinal anesthesia were enrolled. They received 0.5% hyperbaric bupivacaine 12.5 mg, morphine 200 µg and one of the following three solutions: atropine 100 µg intrathecally and saline intravenously; saline intrathecally and atropine 100 µg intravenously; saline only both intravenously and intrathecally. We examined the incidence and severity of PONV, pain ratings and the need for analgesics. RESULTS: We followed 204 parturients. The incidence of PONV was 15%, 37% and 49% in the three groups, respectively (P<0.001). The relative risk reduction for PONV when using intrathecal atropine was 69% vs. placebo and 59% vs. intravenous atropine. No differences were noted in terms of postoperative pain. CONCLUSION: Intrathecal atropine had a significant antiemetic effect, making it a useful adjunct for intrathecal opioid-related PONV.
Assuntos
Analgésicos Opioides/efeitos adversos , Atropina/uso terapêutico , Cesárea , Morfina/efeitos adversos , Antagonistas Muscarínicos/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Analgesia Controlada pelo Paciente , Atropina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Espinhais , Estimativa de Kaplan-Meier , Antagonistas Muscarínicos/administração & dosagem , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Gravidez , Prurido/prevenção & controle , Tamanho da AmostraRESUMO
Alterations in the serological, pulmonary and cardiocirculatory parameters, potentially determined by CO2 pneumo-peritoneum during laparoscopic cholecystectomy, require careful intraoperative evaluation. With the aim of verifying the real entity of these alterations, an experience is reported relating to 76 of the 303 patients undergoing laparoscopic cholecystectomy during 14 months. During surgery, besides an obvious increase in pO2, a slight hypercarbia and a slight decrease in pH were observed, which required pharmacological intervention in only 5 cases. In no case did the respiratory and haemodynamic alterations observed necessitate the conversion into laparotomy. This initial experience gives us reason to conclude that careful monitoring of the respiratory parameters leads to an adequate anaesthesiological conduct, and thus facilitates the completion of laparoscopic procedures.
