Use of Ephedrine for the Short-Term Treatment of Postoperative Nausea and Vomiting: A Case Report

Background. Performing spinal anesthesia with at least hemodynamic variation and complications is always challenging for anesthesiologists. In this study, we investigated the effect of ephedrine and placebo on hemodynamic changes in patients undergoing percutaneous nephrolithotomy with spinal anesthesia. Methods. This randomized, double-blind prospective clinical trial was conducted on 120 patients aged 20‒60 years with ASA (American Society of Anesthesiologists) classes I and II. Patients who were candidates for percutaneous nephrolithotomy with spinal anesthesia were divided into intervention (received 1 cc = 5 mg ephedrine) and control groups (received 1 cc normal saline). All vital parameters, including HR (heart rate) and NIBP (noninvasive blood pressure), were recorded perioperatively T0–T25) and finally at the end of surgery time (Tf). The results were analyzed by SPSS software version 23, and a P value ≤0.05 was considered significant. Results. The mean arterial pressure during surgery between T3 and T9 and the mean heart rate in times of T3–T8 in the intervention group were higher than in the control group, and this difference was statistically significant ( P < 0.05 ). The incidence of hypotension, bradycardia, nausea, and vomiting and the amount of prescribed ephedrine, atropine, and ondansetron in the control group were higher than in the intervention group ( P = 0.001 ). Seven patients in the control group and four in the intervention group had shivering, but this difference was not statistically significant ( P = 0.43 ). Conclusion. This study showed the effectiveness of the prescription of 5 mg ephedrine two minutes before changing from the lithotomy position to the supine in maintaining hemodynamic stability, reducing hypotension, bradycardia, nausea, and vomiting, and the amount of prescribed ephedrine, atropine, and ondansetron. Trial Registrations. This trial is registered with IRCT20160430027677N22.

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“…Ephedrine is a sympathomimetic agent with an antishivering efect and an antiemetic efect in the short term [27,28].…”

Section: Discussionmentioning

confidence: 99%

The Prophylaxis Effect of Ephedrine on Hemodynamic Variation in Patients Undergoing Percutaneous Nephrolithotomy Surgery with Spinal Anesthesia

Sane

Nasiri

Bahrami

et al. 2023

International Journal of Clinical Practice

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“…It also avoids all side effects of ramosetron, palanosetron, dexamethasone and even ephedrine which are being tried in newer studies. [11][12][13]…”

Section: Discussionmentioning

confidence: 99%

Comparison of ondansetron versus chewing gum for prevention of post operative nausea and vomiting in patients undergoing elective LSCS: A randomised control trial

Madhumala¹,

Rohit²,

M³

et al. 2020

IJCA

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Background: Pregnant women are always considered full stomach with high incidence of nausea and vomiting. Anti-emetic efficacy of Ondansetron has been proved in various studies. The aim of this present study is to evaluate efficacy and safety of chewing gum as an alternative to Ondansetron in prevention of postoperative nausea and vomiting (PONV) in parturients undergoing elective LSCS under spinal anesthesia. Materials and Methods: One hundred pregnant women who were found eligible as per inclusion and exclusion criteria were randomized into two equal groups by simple randomization into Group A (n=50) who were given sugar free chewing gum which was to be chewed for 30 minutes three times a day starting immediately after cesarean section and Group B (n=50) who received Inj. Ondanse tron 4mg twice a day post operatively. The outcome measures were episodes of post-operative nausea and vomiting at 6, 12, 18 and 24 hours in both groups, relief of PONV and acceptability of treatment. The secondary outcome measures time to first flatus. Statistical analysis was done through relevant tests using SPSS 16.0. Results: There was no statistically significant difference between the two groups in terms of demographic characteristics such as age, gravidity parity, duration of surgery and type of cesarean section. The incidence of nausea and vomiting was significantly less in Group A compared with Group B at 6 and 12 hours post operatively (p < 0.001). There was no significant difference of this variable at 18 and 24 hours in both groups. The mean average of the first passage of flatus in group A was 20.3±2.01 hours versus 29.6±2.51 hours in Group B (P<0.0001) was significantly shorter compared to the group B. Conclusion: Gum chewing after cesarean section is safe, well tolerated, and acceptable for prevention of post-operative nausea and vomiting and rapid resumption of intestinal motility and has potential impact on reducing the overall healthcare costs in case of routine implementation.

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“…The intervention in our study is non-invasive, very economical and highly patient compliant. It also avoids all side effects of ramosetron, palonosetron, dexamethasone and even ephedrine which are being tried in newer studies [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

A randomised comparative clinical study of the efficacy of ondansetron versus chewing gum for prevention of PONV in patients undergoing elective caesarean

Jain¹

2020

Int. J. Adv. Acad. Stud.

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Aim: to compare the ondansetron versus chewing gum for prevention of post-operative nausea and vomiting in patients undergoing elective LSCS. Material and methods: This was prospective Randomized trial done in the Department of Anesthesia…………….. A total of 120 patients for elective caesarean delivery were included in the study. Patients in Group I were given one strip of sugar free gum to be chewed for 30 minutes every eighth hourly. Patients randomized to Group-II received Inj. Ondansetron 4mg intravenously immediately after cesarean section. The relief of PONV as graded on a four-point verbal descriptive scale, and Five point Likert scale for acceptability, 3) Use of rescue medication for the first 24 hours after surgery 4) Sedation, as assessed with RAMSAY sedation scale and 5) Time to first flatus. Results: 2 patient in chewing gum group and 19 patients in Ondansetron group had episodes of nausea at 6 th hour postoperatively, whereas 2 patient in chewing gum group and 10 patients in Ondansetron group had PONV at 12 th hour. However, rescue medication was not required for these patients. It was observed that there was statistically significant difference between the two groups at 6 th and 12 th hour where the maximum number of events of PONV had occurred. On the scale for relief of PONV, it was observed that there was full resolution of PONV in more number of patients in chewing gum group than in the Ondansetron group. In the Likert scale response, the patients were more comfortable in the chewing gum group than in Ondansetron Group. Our data shows a beneficial effect of gum chewing in terms of better relief of post-operative nausea and shorter mean time intervals to passage of flatus (21.42 versus 30.49 hours) and acceptability. Conclusion: chewing gum is considered safe, well accepted better alternative to Ondansetron for the treatment of PONV in this randomized controlled study undergoing cesarean delivery under spinal anaesthesia. It also results in rapid resumption of intestinal motility, with potential impact on reducing the overall healthcare costs in case of routine implementation.

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Use of Ephedrine for the Short-Term Treatment of Postoperative Nausea and Vomiting: A Case Report

Cited by 5 publications

References 9 publications

The Prophylaxis Effect of Ephedrine on Hemodynamic Variation in Patients Undergoing Percutaneous Nephrolithotomy Surgery with Spinal Anesthesia

The Prophylaxis Effect of Ephedrine on Hemodynamic Variation in Patients Undergoing Percutaneous Nephrolithotomy Surgery with Spinal Anesthesia

Comparison of ondansetron versus chewing gum for prevention of post operative nausea and vomiting in patients undergoing elective LSCS: A randomised control trial

A randomised comparative clinical study of the efficacy of ondansetron versus chewing gum for prevention of PONV in patients undergoing elective caesarean

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