Use of propofol for prevention of post-delivery nausea during cesarean section: a double-blind, randomized, placebo-controlled trial

Abstract

PurposeNausea and vomiting are common, undesirable symptoms during cesarean section. We conducted this study to assess the antiemetic properties of propofol for the prevention and immediate treatment of post-delivery nausea and vomiting during cesarean section under combined spinal–epidural anesthesia.MethodsEighty women undergoing elective cesarean delivery under combined spinal–epidural anesthesia were randomized to receive either propofol at a plasma concentration of 1000 ng/mL or normal saline immediately after clamping of the umbilical cord. The incidence of post-delivery nausea and vomiting, patients requiring rescue antiemetic, bispectral index, sedation score, and the incidence of hypotension were assessed intraoperatively. Satisfaction and neonatal behavioral neurological assessments were evaluated postoperatively.ResultsThe incidence of nausea was significantly lower in the propofol group compared to the placebo group (25% versus 60%, P < 0.001). The incidence of retching and vomiting showed no significant difference between the two groups. Propofol 20 mg as a rescue antiemetic was significantly effective in both the groups. Satisfaction level of patients and obstetricians in the propofol group was higher than in the placebo group. There was no statistical difference in the incidence of hypotension between the two groups both pre- and post-delivery. There was no difference in postoperative neonatal behavioral neurological assessment between groups.ConclusionPropofol at a plasma concentration of 1000 ng/mL significantly reduced the incidence of post-delivery nausea compared to placebo, but had no effect on reducing retching or vomiting episodes during cesarean section.

The Effect of Intravenous Infusion of Propofol or Aminophylline on Incidence and Severity of Post-dural Puncture Headache in Elective Cesarean Section

“…This may be attributed to the anti-emetic effect of propofol. This also agreed with the results of the study conducted by Niu et al (29) , as they showed that the incidence of IONV was lower in the propofol group when compared to placebo in parturients undergoing spinal anesthesia for elective cesarean section.…”

Comparison of the combination of propofol and etomidate versus propofol or etomidate alone for induction of general anesthesia: a double-blind, randomized controlled trial

“…Propofol has an antiemetic property, and the antiemetic action is attributed to a decrease in 5-HT levels in the area postrema and probably through its action on the GABA receptors [47]. Some studies have demonstrated that it can effectively decrease the incidence of PONV, which is cited as a common side-effect of etomidate [14,[48][49][50]. However, other studies found that etomidate did not increase the incidence of PONV [51,52].…”

Adverse Events during Vitreoretinal Surgery under Adequacy of Anesthesia Guidance—Risk Factor Analysis

“…As only 1.6% of subjects were obese in the study of Nitahara et al [18], which showed a decreased incidence of PONV in this group of patients, in contrast to 10.1% in the review of Kranke et al [30], the conclusion regarding no influence of BMI > 30 on the rate of PONV is convincing. Kim et al [31], in their study of 113,881 patients who underwent GA, showed that an increased BMI reduced the incidence of PONV [26], whereas being underweight did not. In the current study, the number of overweight patients was 72 (41.4%), whereas obesity was noted in 52 (29.9%).…”

“…Similar to the observations of Apfel et al [23], they also found that inhalational anesthesia correlated with increased incidence of nausea, observed in 24 cases compared to 6 incidences in propofol anesthesia. Propofol was found to reduce the rate of incidence of PONV due to its direct antiemetic properties [24] that are widely used to prevent PONV in patients undergoing thyroidectomy [25], cesarean section [26] and laparoscopic cholecystectomy [27]. Nevertheless, during maintenance of GA we used sevoflurane due to its pre-conditioning properties of ameliorating myocardial ischemia/reperfusion injury in diabetic patients [28] who constituted about 44% of patients in our study.…”