Effect of Intraoperative Dextrose Infusion for Prevention of Postoperative Nausea and Vomiting in Diagnostic Gynecologic Laparoscopy

Objective: Laparoscopic procedures are accompanied with a high occurrence of nausea and vomiting after surgery. This study aimed to evaluate the effectiveness of prophylactic intraoperative infusion of dextrose 5% in the avoidance of postoperative nausea and vomiting (PONV). Materials and Methods: In this randomized, double-blind, placebo-controlled clinical trial, 70 ASA class I women, aged 20-40 years scheduled for diagnostic laparoscopy for infertility were studied. Following induction of anesthesia, study group (n = 35) received Ringer"s solution 10 mL/kg/h with glucose 500 mg/kg (dextrose 5%) and placebo group (n = 35) received Ringer"s solution with normal saline 0.9% in the same volume intraoperatively. The incidence and severity of PONV according to a 4-point scale (0-3) in the post-anesthesia care unit (PACU) and during the first 24 postoperative hours, the first request for antiemetic, and overall antiemetic consumption were compared between 2 groups. Results: The overall incidence of PONV was certainly lower in the study group compared with the placebo group (22.85% vs. 45.71%; P = 0.03). Severity of PONV was significantly lower in the study group (1.14 ± 0.32) compared to the placebo group (2.50 ± 0.27) (P = 0.03). There was a statistically significant difference between 2 groups regarding the first request for antiemetic after surgery (7.1 ± 1.13 vs. 5.71 ± 1.76 hours, P = 0.04) and total dose of antiemetic (metoclopramide, 60 vs. 100 mg, P = 0.001). There was no significant difference in perioperative blood sugar levels between 2 groups (P = 0.46). Conclusion: Intraoperative infusion of dextrose 5% was found to be an efficacious method in the prevention/reduction of PONV without any significant difference in postoperative blood sugar levels in patients undergoing diagnostic gynecologic laparoscopy

Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial

Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S. Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher’s exact test, one-way ANOVA, Mann-Whitney U-test, and student’s t test. Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant (40.47% vs. 61.9%, P=0.08). The duration of hypotension was shorter in the study group (1.6±7.8 min vs. 7.4±12.5 min, P=0.004). The dose of ephedrine was lower in the study group (2.4±6.6 mg vs. 5.3±10.7 mg, P=0.006). The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 (16.66%) of hyperbaric groups (P=0.006). None of the neonates had Apgar score≤7 at 5 min of delivery (P=1.0). Sensory and motor block duration was shorter in the study group (P=0.01). Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S. Trial Registration Number: IRCT201401287013N