Epidural ondansetron is more effective to prevent postoperative pruritus and nausea than intravenous ondansetron in elective cesarean delivery
|
|
- William Montgomery
- 5 years ago
- Views:
Transcription
1 Acta Obstetricia et Gynecologica. 007; 86: ORIGINAL ARTICLE Epidural ondansetron is more effective to prevent postoperative pruritus and nausea than intravenous ondansetron in elective cesarean delivery DONG WOO HAN 1, SOON WON HONG, JA-YOUNG KWON, JAE WOO LEE 1 & KI JUN KIM 1 1 Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Department of Pathology, and Department of Obstetrics and Gynecology, International Health Care Center, Yonsei University College of Medicine, CPO Box 8044, Seoul 10-75, Korea Abstract Background. Postoperative pruritus, nausea, and vomiting are common side effects of intrathecal or epidural opioids. Intravenous ondansetron has been used for postoperative emesis. However, there are no reports regarding epidural ondansetron. Two studies were conducted to evaluate the prophylactic effects of epidural ondansetron for opioid-induced pruritus, nausea, and vomiting. Methods. Neurotoxic signs were checked after epidural injection of ondansetron in rats. A clinical study was conducted to compare the prophylactic effects of epidural ondansetron with intravenous ondansetron for opioid-induced pruritus, nausea, and vomiting in cesarean delivery. Results. No neurotoxic evidence was found in rats. The incidence of pruritus and nausea was significantly lower in the epidural ondansetron group than in the intravenous ondansetron group at 4 and 48 h postoperatively. Conclusions. Epidural ondansetron is more effective in preventing postoperative pruritus and nausea than intravenous ondansetron. Key words: Nausea, ondansetron, pruritus Postoperative pruritus, nausea, and vomiting are common side effects of intrathecal (IT) or epidural (EP) opioids (1). Ondansetron, a selective 5-HT receptor antagonist, has been used for nausea and vomiting in chemotherapy. However, Sarvela et al. () recently reported that intravenous (IV) ondansetron did not prevent IT opioid-induced pruritus. It has been known that 5-HT receptors are related to pruritus and emesis (). 5-HT receptors are abundant in the medulla and dorsal horn of the spinal cord (4). Therefore, EP ondansetron may be more effective in preventing neuraxial opioid-induced pruritus, nausea, and vomiting than IV ondansetron. However, reports on the effects of EP ondansetron are lacking. A clinical study was performed to compare the effects of EP ondansetron with IV ondansetron for prophylaxis of opioid-induced pruritus, nausea, and vomiting in cesarean delivery after an animal study. Material and methods The study was approved by the Yonsei University Animal Research Ethics Committee. Male Sprague Dawley rats (18000 g) were used. The rats were anesthetized using enflurane in 95% oxygen. An 8-cm polyethylene catheter (PE-10 TM, Becton Dickinson, USA) was advanced caudally through the atlanto-occipital membrane. After surgery, the rats were allowed to recover for one week and observed. Only those rats having normal motor behavior were included in this study. Correspondence: Ki Jun Kim, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, CPO Box 8044, Seoul 10-75, Korea. kkj606@yumc.yonsei.ac.kr (Received 11 September 006; accepted February 007) ISSN print/issn online # 007 Taylor & Francis DOI: /
2 684 D.W. Han et al. Seven days after operation, 18 rats in the study were randomly assigned to one of three groups: 1. ondansetron (Zofran TM, GlaxoSmithKline, UK) 10-mg group (n6);. ondansetron 0-mg group (n6); and. 0.9% normal saline group (n6). Ondansetron was given intrathecally in a volume of 10 ml, and the catheter was flushed with 10 ml of normal saline. In the saline group, the animals were given 0 ml of saline. The injections were done in each animal once daily between 6 and 7 a.m. for 14 days. Neurological functions such as posture, gait, eating habits, and righting reflexes were observed. Twenty-four hours after the last IT injection, the rats were anesthetized with enflurane and the L1 segment of the spinal cord was excised. The segment was cut coronally and slices were stained with hematoxylin-eosin. The ultrathin sections were stained with uranyl acetate and examined under an electron microscope. A pathologist who was blinded to the experiment analyzed the slides. The study was approved by the institutional review board and written informed consent was obtained. Sample size was predetermined using a power analysis based on the assumptions that: a. the incidence of pruritus in patients undergoing IV ondansetron would be about 50%; b. reduction of pruritus from 50% to 0% was considered as having clinical importance; and c. a0.05 with a power of 0.8. Eighty-two pregnant women (ASA I) who were scheduled for cesarean delivery were included. Combined spinal EP anesthesia was conducted. All patients received a single injection of 10 mg of hyperbaric bupivacaine (Marcaine TM, AstraZeneca) and fentanyl (15 mg). An EP catheter was inserted. The surgical technique was kept uniform for all patients. After delivery of the fetus, all patients were given 4 mg ondansetron intravenously over a minute. Then, patients were randomly allocated into two groups using a random number sequence. After the operation, ondansetron (8 mg/4 ml) (IV group) or 0.9% normal saline (4 ml) (EP group) mixed with normal saline 1,000 ml was continuously infused intravenously for 48 h (1 ml/h). Simultaneously, continuous EP infusion was initiated by attaching Two-day Infusors TM (Baxter, USA) containing either 7 mg morphine sulfate in 100 ml of 0.% ropivacaine (Naropin TM, AstraZeneca) (IV group) or 8 mg ondansetron and 7 mg morphine sulfate in 100 ml of 0.% ropivacaine (EP group). The study drugs were prepared by an anesthesiologist who was not participating in the evaluation of the patients. The incidence and degree of nausea, vomiting, pruritus, pain, and side effects such as headache, cardiac arrhythmia (with stethoscope), and extrapyramidal symptoms were assessed by an anesthesiologist who was blinded to the groups during the following 48 h. The degrees of nausea, vomiting, pruritus, and pain are shown in Table I. When of pruritus or nausea was required, diphenhydramine (5 mg) or metoclopramide (5 mg) was administered. Demographic variables between the two groups were compared using the t-test. The incidence and severity of nausea, vomiting, pruritus, and pain were analyzed by chi-square test. Data were presented as mean9sd and a p value of 0.05 or less was considered significant. Results All rats showed normal behaviors and motor functions. Macroscopic examinations of the spinal cord revealed that the catheter tip was located at the lumbar enlargement area in all rats. Hemorrhage or necosis was not found. Under light and electron microscopy, there were no specific morphological Table I. The grades for nausea, vomiting, pruritus, and pain. Condition Grading criteria Nausea 0 No nausea 1 Mild nausea, not requesting pharmacological Moderate nausea, requesting pharmacological Severe nausea resistant to pharmacological Vomiting 0 No vomiting 1 Mild vomiting, not requesting pharmacological Moderate vomiting, requesting pharmacological Severe vomiting resistant to pharmacological Pruritus 0 No pruritus 1 Mild pruritus not requesting pharmacological Moderate pruritus, requesting pharmacological Severe pruritus resistant to pharmacological Pain 0 No pain 1 Mild pain, not requesting pharmacological Moderate pain, requesting pharmacological Severe pain resistant to pharmacological
3 The effect of epidural ondansetron 685 Figure 1. Spinal cord of normal saline administered rat (A: H&E, #40; B: H&E, #00; C: EM, #4,400) and spinal cord of ondansetron 0 mg administered rat (D: H&E, #40; E: H&E, #00; F: EM, #4,400). Pictures of spinal cord of ondansetron 10 mg administered rat were not shown. In lower power view, there is no identifiable histologic difference such as hemorrhage, necrosis, or edema among the groups. In medium power view, there is also no identifiable inflammation, vasculitis, or necrosis in experimental groups. Ultrastructural manifestations have no specific differences among the groups and shapes of microstructures of experimental groups are normal. Black arrow indicates mitochondria and white arrow indicates RBC. The calibration bars represent 5 mm for all electromicroscopic photographs or histological changes in any the three groups (Figure 1). Eighty patients (40 in each group) completed the protocol. Two patients were excluded due to accidental removal of the EP catheter (IV group) and postoperative bleeding (EP group). There were no differences in the demographic characteristics between the two groups (Table II). Table II. Patients characteristics. IV group (n40) EP group (n40) Age (years) Weight (kg) Height (cm) Operation time (min) Anesthesia time (min) There is no specific difference between two groups. The overall incidence of pruritus was significantly lower in the EP group (.5% and 15%) than that in the IV group (55% and 0%) at 4 and 48 h postoperatively (p B0.05). Four patients (10%) in the IV group experienced moderate pruritus compared with none in the EP group 4 h postoperatively. The overall incidence of nausea was significantly lower in the EP group (5% and 10%) compared with the IV group (45% and 5%) at 4 and 48 h postoperatively (p B0.05). There were no differences in the incidence and severity in vomiting and pain between the two groups (Tables III and IV). No side effects such as headache, cardiac arrhythmia, and extrapyramidal symptoms were found in either group. No evidence of neurologic impairment was detected in any of the patients. Discussion Ondansetron can be administered via oral, IV, intramuscular, subcutaneous, and sublingual routes. However, no information on the EP injection of ondansetron in humans has been reported except for
4 686 D.W. Han et al. Table III. The number of patients for nausea, vomiting, pruritus, and pain at 4 h postoperatively. Grade IV group (n40) EP group (n40) Nausea 0 (55.0%) 0 (75.0%)* 1 15 (7.5%) 8 (0.0%)* (7.5%) (5.0%) Vomiting 0 4 (85.0%) 6 (90.0%) 1 6 (15.0%) 4 (10.0%) Pruritus 0 18 (45.0%) 1 (77.5%)* 1 18 (45.0%) 9 (.5%)* 4 (10.0%) Pain 0 6 (90.0%) 7 (85.0%) 1 4 (10.0%) (15.0%) 0, none; 1, mild;, moderate;, severe. Values are the number of patients and percent. *p B0.05. one case report. Ondansetron had been inadvertently administered into the EP space in a parturient patient but there were no neurologic sequelae (5). Neurotoxicity after neuraxial administration is related to many factors such as ph, osmolarity, preservatives, concentration, dose, and duration Table IV. The number of patients for nausea, vomiting, pruritus, and pain at 48 h postoperatively. Grade IV group (n40) EP group (n40) Nausea 0 6 (65.0%) 6 (90.0%)* 1 1 (0.0%) (7.5%)* (5.0%) 1 (.5%) Vomiting 0 7 (9.5%) 9 (97.5%) 1 (7.5%) 1 (.5%) Pruritus 0 4 (70.0%) 4 (85.0%)* 1 16 (0.0%) 6 (15.0%)* Pain 0 6 (90.0%) 8 (95.0%) 1 4 (10.0%) (5.0%) 0, none; 1, mild;, moderate;, severe. Values are the number of patients and percent. *p B0.05. (6,7). Ondansetron is stable and osmolarity is 70 mosm/l; pka is 7.4 and ph is 4.6, which is similar to lidocaine mixed with epinephrine (8). Ondansetron injectate contains no preservatives (9). We examined the histopathological changes of the spinal cord after IT administration of ondansetron. Although the IT and EP drug may have different mechanisms of action, histological damage is considered more severe after IT injection than EP injection. The spinal cord concentration of ondansetron after IT administration may be much higher than that after EP administration due to the barrier function of the dura (6). Therefore, spinal administration of a certain drug is considered a more appropriate route for evaluation of neurotoxicity. The large concentrations and doses were demonstrated to have neurotoxic potential (7). Much smaller IT doses are usually required for an equal effect compared to EP doses (6). An IT 0 mg of ondansetron in rat corresponds to approximately 78 mg/day in parturient women on a weight basis, which is above the recommended clinical dose. Therefore, continuous administration of EP ondansetron diluted in local anesthetics in human would be expected to produce much lower concentrations in the spinal cord than in rats. Pruritus is a common adverse effect of neuraxial opioids. It occurs more often in the obstetric population, which may result from an interaction of estrogen with opioid receptors (10). This type of pruritus is resistant to conventional and therefore requires drugs such as histamine blockers, propofol, and opioid antagonists. Histamine blockers and propofol have limitations because of sedation and reversal of analgesia (11). Pruritus associated with neuraxial opioids results from activation of m-opioid receptors or non-nociceptive neurons in the medulla and dorsal horn of the spinal cord involving the trigeminal nerve distribution (1). Direct stimulation of 5-HT receptors is another mechanism (). When administered epidurally, ondansetron could more easily reach and provide a higher concentration at the spinal dorsal horn. A small fraction of EP ondansetron might be absorbed systemically through EP venous plexus and have a supraspinal anti-pruritic effect. In patients receiving EP morphine, the incidence of nausea and vomiting is frequent (0 50%). Although prophylactic IV ondansetron has prevented opioid-induced nausea and vomiting, certain studies failed to demonstrate an anti-emetic effect (1,14).
5 The effect of epidural ondansetron 687 During general anesthesia, 5-HT is released from the enterochromaffin cells of the gastrointestinal tract (15). Released 5-HT sends impulses via vagal afferents to the chemoreceptor trigger zone (CTZ) in the area postrema and then to the vomiting center. Therefore, postoperative nausea and vomiting can be prevented or treated by blocking either peripheral or central 5-HT receptors. The role of ondansetron in blocking central 5-HT receptors would be more effective than peripheral 5-HT receptors for reducing neuraxial opioid-induced nausea and vomiting due to the central migration of opioids. Ondansetron might be involved in the pain pathway through various serotonergic systems (16). Ondansetron has a potent local anesthetic effect that blocks sodium channels and interrupts spinal nerve conduction (17). Therefore, it would be expected that EP ondansetron might produce an analgesic effect, although IV ondansetron has been reported to have little effect on postoperative pain (18,19). It might be difficult to determine whether EP ondansetron would have any antinociceptive effect as the opioid and local anesthetics administered with ondansetron prevented postoperative pain so efficiently. The most common adverse effect after systemic administration of ondansetron is headache, which is dose dependent (0). EP administration of a drug may reduce the development of systemic side effects of the drug due to its lower plasma concentration (1). In conclusion, EP ondansetron is more effective in preventing postoperative pruritus and nausea than IV ondansetron. References 1. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth. 1995;/4:/ Sarvela PJ, Halonen PM, Soikkeli AI, Kainu JP, Korttila KT. Ondansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand. 006;/50:/944.. Yeh HM, Chen LK, Lin CJ, Chan WH, Chen YP, Lin CS, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg. 000;/91:/ Laporte AM, Doyen C, Nevo IT, Chauveau J, Hauw JJ, Hamon M. Autoradiographic mapping of serotonin 5-HT1A, 5-HT1D, 5-HTA and 5-HT receptors in the aged human spinal cord. J Chem Neuroanat. 1996;/11:/ Huang JJ. Inadvertent epidural injection of ondansetron. J Clin Anesth. 006;/18:/ Kirihara Y, Saito Y, Sakura S, Hashimoto K, Kishimoto T, Yasui Y. Comparative neurotoxicity of intrathecal and epidural lidocaine in rats. Anesthesiology. 00;/99:/ Yamashita A, Matsumoto M, Matsumoto S, Itoh M, Kawai K, Sakabe T. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine, and ropivacaine administered intrathecally in rabbits. Anesth Analg. 00;/97:/ Simpson KH, Hicks FM. Clinical pharmacokinetics of ondansetron. A review. J Pharm Pharmacol. 1996;/48:/ Malinovsky JM, Lepage JY, Cozian A, Mussini JM, Pinaudt M, Souron R. Is ketamine or its preservative responsible for neurotoxicity in the rabbit? Anesthesiology. 199;/78:/ Chadwick HS, Ready LB. Intrathecal and epidural morphine sulfate for post-cesarean analgesia a clinical comparison. Anesthesiology. 1988;/68:/ Borgeat A, Wilder-Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. Anesthesiology. 199;/76:/ Thomas DA, Williams GM, Iwata K, Kenshalo DR Jr, Dubner R. The medullary dorsal horn. A site of action of morphine in producing facial scratching in monkeys. Anesthesiology. 199;/79:/ Pitkanen MT, Numminen MK, Tuominen MK, Rosenberg PH. Comparison of metoclopramide and ondansetron for the prevention of nausea and vomiting after intrathecal morphine. Eur J Anaesthesiol. 1997;/14:/ Millo J, Siddons M, Innes R, Laurie PS. Randomized doubleblind comparison of ondansetron and droperidol to prevent postoperative nausea and vomiting associated with patientcontrolled analgesia. Anaesthesia. 001;/56:/ Roila F, Ballatori E, Tonato M, Del Favero A. 5-HT receptor antagonists: differences and similarities. Eur J Cancer. 1997;/:/ Bardin L, Lavarenne J, Eschalier A. Serotonin receptor subtypes involved in the spinal antinociceptive effect of 5-HT in rats. Pain. 000;/86:/ Ye JH, Mui WC, Ren J, Hunt TE, Wu WH, Zbuzek VK. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg. 1997;/85:/ Davies PR, Warwick P, O Connor M. Antiemetic efficacy of ondansetron with patient-controlled analgesia. Anaesthesia. 1996;/51:/ Yazigi A, Chalhoub V, Madi-Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanil-morphine. J Clin Anesth. 00;/14:/ Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;/87:/ Lee IH, Lee IO. Antipruritic and antiemetic effect of epidural droperidol: comparative study between single and continuous epidural injection. Eur J Anaesthesiol. 006;/:/18.
Childbirth via cesarean delivery accounted for
Pharmacologic Methods for Preventing Pruritus in Patients Receiving Intrathecal Opioids for Cesarean Delivery Katrina Vice-O Con, DNAP, CRNA Paul N. Austin, PhD, CRNA Marilyn A. Pugh, PhD Neuraxial anesthesia
More informationEvaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
More informationRam Bhakta Koju 1,2*, Bandana Sharma Gurung 3 and Yashad Dongol 4
Koju et al. BMC Anesthesiology 2015, 15:18 RESEARCH ARTICLE Open Access Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting
More informationEffects of IV Ondansetron during spinal anaesthesia with Ropivacaine and Fentanyl
Original article Effects of IV Ondansetron during spinal anaesthesia with Ropivacaine and Fentanyl 1Dr Bipul Deka, 2 Dr Bharat Talukdar, 3 Dr. Amal Kumar Laha, 4 Dr. Rupak Bhattacharjee 1Assistant Professor,
More informationEfficacy of Prophylactic Ondansetron in a Patient-controlled Analgesia Environment
The Journal of International Medical Research 2004; 32: 160 165 Efficacy of Prophylactic Ondansetron in a Patient-controlled Analgesia Environment SH HAN, YJ LIM, YJ RO, SC LEE, YS PARK AND YC KIM Department
More informationHemodynamic changes of intrathecal hyperbaric ropivacaine and bupivacaine in
Research Article Hemodynamic changes of intrathecal hyperbaric ropivacaine and bupivacaine in Lower abdoal surgeries- a comparative study Assistant Professor, Department of Anaesthesiology, Critical care
More informationA COMPARATIVE STUDY OF NEURAXIAL BLOCK FOR POST-CESAREAN ANALGESIA AND SIDE EFFECTS: INTRATHECAL VS EPIDURAL MORPHINE
A COMPARATIVE STUDY OF NEURAXIAL BLOCK FOR POST-CESAREAN ANALGESIA AND SIDE EFFECTS: INTRATHECAL VS EPIDURAL MORPHINE Chung M Chan 1, Saw K Cheah 1, Muhammad Maaya 1, Rufinah Teo 1, Su Y Loo 2, Thohiroh
More informationISSN X (Print) India. *Corresponding author Dr. D. Shiva Prasad
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(9C):3311-3315 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationNON-OPIOID ANALGESIA & THE IMPLICATIONS OF ANESTHETIC DRUGS IN THE PERI-ANESTHETIC ARENA AMANDA AFFLECK CRNA
NON-OPIOID ANALGESIA & THE IMPLICATIONS OF ANESTHETIC DRUGS IN THE PERI-ANESTHETIC ARENA AMANDA AFFLECK CRNA OR, ANESTHESIA, WHY DO THEY DO THAT? OUTLINE Neurotransmission of pain Arachidonic Acid pathway
More informationPost Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark
Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan
More informationDexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy
Original Research Article Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy T. Uma Maheswara Rao * Associate Professor, Department of Surgery, Konaseema Institute
More informationEffect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids: a quantitative systematic review
British Journal of Anaesthesia 101 (3): 311 19 (2008) doi:10.1093/bja/aen202 Advance Access publication July 7, 2008 Effect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids:
More informationOB Div News March 2009
OB Div News March 2009 Several articles in this month s review have come from Canadian institutions. In spite of my pride in being Canadian, which was enhanced during the Olympics, this is purely coincidental.
More informationEffects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery
Effects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery Z.-M. Xing*, Z.-Q. Zhang*, W.-S. Zhang and Y.-F. Liu Anesthesia Department, No. 1 People s Hospital of Shunde, Foshan,
More informationIntrathecal 0.75% Isobaric Ropivacaine Versus 0.5% Heavy Bupivacaine for Elective Cesarean Delivery: A Randomized Controlled Trial
Intrathecal 0.75% Isobaric Ropivacaine Versus 0.5% Heavy Bupivacaine for Elective Cesarean Delivery: A Randomized Controlled Trial Surjeet Singh, 1 V.P. Singh, 2 Manish Jain, 3 Kumkum Gupta, 3 Bhavna Rastogi,
More informationJ Med Assoc Thai 2016; 99 (5): Full text. e-journal:
A Randomized Placebo-Controlled Trial of Oral Ramosetron for Prevention of Post Operative Nausea and Vomiting after Intrathecal Morphine in Patients Undergoing Gynecological Surgery Suratsawadee Wangnamthip
More informationAntiemetic Effect Of Propofol Administered At The End Of Surgery
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 11 Ver. III (November. 2016), PP 54-58 www.iosrjournals.org Antiemetic Effect Of Propofol Administered
More informationRegional Anaesthesia for Caesarean Section Warwick D. Ngan Kee
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee Chair, Department of Anesthesiology Sidra Medicine Doha, Qatar D I S C L O S U R E S No financial disclosures No industry affiliations No
More informationProphylactic mirtazapine reduces intrathecal morphine-induced pruritus
British Journal of Anaesthesia 101 (5): 711 15 (2008) doi:10.1093/bja/aen241 Advance Access publication August 18, 2008 Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus M. J. Sheen
More informationComplications of analgesic therapy in children
Complications of analgesic therapy in children John B. Rose, M.D. Director, Pain Management Service Department of Anesthesiology & Critical Care Medicine Children s Hospital of Philadelphia Philadelphia,
More informationMeasure Abbreviation: PONV 01 (MIPS 430)
Measure Abbreviation: PONV 01 (MIPS 430) *PONV 01 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 430: Prevention of Post-Operative Nausea and Vomiting (PONV) Combination
More informationMorphine for post-caesarean section analgesia: intrathecal, epidural or intravenous?
O r i g i n a l A r t i c l e Singapore Med J 2005; 46(8) : 392 Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous? Y Lim, S Jha, A T Sia, N Rawal ABSTRACT Introduction:
More informationProphylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil
REGIONAL ANESTHESIA AND PAIN 685 Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil [L administration prophylactique d ondansétron ne réduit pas l incidence
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationComparison of local anesthetic effects of Tramadol and Lidocaine used subcutaneously in minor surgeries with local anesthesia
Comparison of local anesthetic effects of Tramadol and Lidocaine used subcutaneously in minor surgeries with local anesthesia S. Vahabi **, M. Heidari **, M. Ahmadinejad ***, J. Akhlaghi **** and M. Birjandi
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
More informationInitiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany
Initiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany Kenneth E Nelson, M.D. Associate Professor Wake Forest University, North Carolina, USA Initiating
More informationRegional Anaesthesia for Caesarean Section
Regional Anaesthesia for Caesarean Section "The Best Recipe" Warwick D. Ngan Kee Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong What I will not do. Magic recipes One shoe to fit
More information*Corresponding author:
A randomized controlled trial to evaluate the effect of addition of a single dose of epidural magnesium sulphate on the duration of postoperative analgesia in patients undergoing lower abdominal surgeries
More informationThe use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study
Kasr El Aini Journal of Surgery VOL., 10, NO 3 September 2009 97 The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study Sherif Adly and Mohamed
More informationIJMDS January 2017; 6(1) Dr Robina Makker Associate professor 2 Dr Amit Bhardwaj
Original Article Comparative efficacy of ondansetron versus granisetron to prevent perioperative nausea and vomiting in patients undergoing gynaecological surgery under spinal anaesthesia Makker R 1, Bhardwaj
More informationWITH ISOBARIC BUPIVACAINE (5 MG/ML)
, 49, 2013, 3 63 (5 MG/ML) (5 MG/ML).,.,.,..,..,, SPINAL ANESTHESIA: COMPARISON OF ISOBARIC ROPIVACAINE (5 MG/ML) WITH ISOBARIC BUPIVACAINE (5 MG/ML) D. Tzoneva, Vl. Miladinov, Al. Todorov, M. P. Atanasova,
More informationAs laparoscopic surgeries are gaining popularity, Original Article. Maharjan SK 1, Shrestha S 2 1. Introduction
, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 Original Article Maharjan SK 1, Shrestha S 2 1 Associate Professor, 2 Assistant Professor, Department of Anaesthesiology and Intensive Care Kathmandu Medical College,
More informationComparative Study of Equal Doses of Intrathecal Isobaric Bupivacaine and Isobaric Ropivacaine for Lower Limb Surgeries and Perineal Surgeries
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/229 Comparative Study of Equal Doses of Intrathecal Isobaric Bupivacaine and Isobaric Ropivacaine for Lower Limb Surgeries
More informationIntraspinal (Neuraxial) Analgesia Community Nurses Competency Test
Intraspinal (Neuraxial) Analgesia Community Nurses Competency Test 1 Intraspinal (Neuraxial) Analgesia for Community Nurses Competency Test 1) Name the two major classifications of pain. i. ii. 2) Neuropathic
More informationBeneficial effects of the addition of intrathecal fentanyl to bupivacaine for spinal anesthesia in cesarean section
Anesth Pain Med 2017; 12: 233-239 https://doi.org/10.17085/apm.2017.12.3.233 Clinical Research http://crossmark.crossref.org/dialog/?doi=10.17085/apm.2017.12.3.233&domain=pdf&date_stamp=2017-07-25 pissn
More informationJ. Basic. Appl. Sci. Res., 2(9) , , TextRoad Publication
2012, TextRoad Publication ISSN 2090-4304 Journal of Basic and Applied Scientific Research www.textroad.com The Evaluation of Post Spinal Anesthesia Nausea and Vomiting Incidence with Lidocaine Versus
More informationMeasure Abbreviation: PONV 01 (MIPS 430)
Measure Abbreviation: PONV 01 (MIPS 430) *PONV 01 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 430: Prevention of Post-Operative Nausea and Vomiting (PONV) Combination
More informationImpact of Baricity of Bupivacaine on Intrathecal Fentanyl- Associated Pruritus during Combined Spinal/Epidural Anesthesia for Labor
ISPUB.COM The Internet Journal of Anesthesiology Volume 20 Number 1 Impact of Baricity of Bupivacaine on Intrathecal Fentanyl- Associated Pruritus during Combined Spinal/Epidural Anesthesia for Labor R
More informationDEXAMETHASONE WITH EITHER GRANISETRON OR ONDANSETRON FOR POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC SURGERY
DEXAMETHASONE WITH EITHER GRANISETRON OR ONDANSETRON FOR POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC SURGERY Alia S. Dabbous *, Samar I. Jabbour-Khoury **, Viviane G Nasr ***, Adib A Moussa ***,
More informationGI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics. Dr. Alia Shatanawi
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics Dr. Alia Shatanawi 11-04-2018 Drugs used in Irritable Bowel Syndrome Idiopathic, chronic, relapsing disorder characterized by abdominal discomfort
More informationPreventing Nausea and Vomiting Using Ondansetron and Metoclopramide-Phenylephrine in Cesarean Section Using Spinal Anesthesia
http://www.cjmb.org Open Access Original Article Crescent Journal of Medical and Biological Sciences Vol. 6, No. 1, January 2019, 61 65 eissn 2148-9696 Preventing Nausea and Vomiting Using Ondansetron
More informationEfficacy of Intramuscular Nalbuphine versus Diphenhydramine for the Prevention of Epidural Morphine-induced Pruritus after Cesarean Delivery
Original Article 172 Efficacy of Intramuscular Nalbuphine versus Diphenhydramine for the Prevention of Epidural Morphine-induced Pruritus after Cesarean Delivery Chia-Chih Liao, MD; Chieh-Szu Chang, MD;
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. To study the occurrence of postoperative hyponatremia in paediatric patients under 2 years of age 2. Influence of timing of intravenous fluid therapy on maternal hemodynamics in patients undergoing
More informationOriginal Article Does droperidol have a good effect of preventing morphine-induced pruritus in adults? A meta-analysis
Int J Clin Exp Med 2016;9(6):10883-10890 www.ijcem.com /ISSN:1940-5901/IJCEM0024571 Original Article Does droperidol have a good effect of preventing morphine-induced pruritus in adults? A meta-analysis
More informationAntiemetic in Caesarean section under spinal anaesthesia: new option
IOSR Journal of Pharmacy and Biological Sciences (IOSRJPBS) ISSN : 2278-3008 Volume 3, Issue 2 (Sep-Oct 2012), PP 01-05 Antiemetic in Caesarean section under spinal : new option Balaram Ghosh 1, Suman
More informationCombination of Ultra-low Dose Bupivacaine and Fentanyl for Spinal Anaesthesia in Out-patient Anorectal Surgery
The Journal of International Medical Research 2008; 36: 964 970 Combination of Ultra-low Dose Bupivacaine and Fentanyl for Spinal Anaesthesia in Out-patient Anorectal Surgery A GURBET, G TURKER, NK GIRGIN,
More informationNEUROLOGICAL TOXICITY OF THE SUBARACHNOID INFUSION OF BUPIVACAINE, LIGNOCAINE OR 2-CHLOROPROCAINE IN THE RAT
Br.J. Anaesth. (98),, -9 NEUROLOGICAL TOXICITY OF THE SUBARACHNOID INFUSION OF BUPIVACAINE, LIGNOCAINE OR -CHLOROPROCAINE IN THE RAT D. F. LI, M. BAHAR, G. COLE AND M. ROSEN Neurological deficit after
More informationReply to the Joint Editors-in-Chief Request for Determination Regarding Papers Published by Dr. Yoshitaka Fujii, dated April 9, 2012
Reply to the Joint Editors-in-Chief Request for Determination Regarding Papers Published by Dr. Yoshitaka Fujii, dated April 9, 2012 December 26, 2012 Research Integration Committee, University of Tsukuba
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationAn Epidural Initial Dose is Unnecessary in Combined Spinal Epidural Anesthesia for Caesarean Section
Original An Epidural Initial Dose is Unnecessary in Combined Spinal Epidural Anesthesia for Caesarean Section Takashi Hongo, Akira Kitamura, Motoi Yokozuka, Chol Kim and Atsuhiro Sakamoto Department of
More informationComparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block
Original Research Article Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block S. Arul Rajan 1, N. Sathyan 2*, T. Murugan 3 1 Assistant
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More informationINTRATHECAL FENTANYL ADDED TO LIDOCAINE FOR CESAREAN DELIVERY UNDER SPINAL ANESTHESIA
INTRATHECAL FENTANYL ADDED TO LIDOCAINE FOR CESAREAN DELIVERY UNDER SPINAL ANESTHESIA - A Randomised Clinical Trial - * AND KHOOSHIDEH M ** Abstract The addition of opioids to local anesthetics improves
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationEpidural Analgesia in Labor - Whats s New
Epidural Analgesia in Labor - Whats s New Wichelewski Josef 821 Selective neural blockade has many clinical applications in medicine but nowhere has its use been so well accepted than in the field of Obstetrics.
More informationUpdate Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
More informationA comparative study of the antiemetic efficacy of dexamethasone, ondansetron, and metoclopramide in patients undergoing gynecological surgery
Med Sci Monit, 2010; 16(7): CR336-341 PMID: 20581776 WWW.MEDSCIMONIT.COM Clinical Research Received: 2008.04.25 Accepted: 2009.05.31 Published: 2010.07.01 A comparative study of the antiemetic efficacy
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationUneventful recovery following accidental epidural injection of dobutamine
1 Case report Uneventful recovery following accidental epidural injection of dobutamine Bastiaan M. Gerritse, M.D., Ph.D., Daan de Vos, R.N.A, Anton W. Visser, M.D., Ph.D. Department of Anesthesiology,
More informationComparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery
ISPUB.COM The Internet Journal of Anesthesiology Volume 30 Number 4 Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery U Srivastava, K Joshi, A Gupta, Y Dwivedi, H
More informationPatient-controlled epidural Levobupicvacaine with or without Fentanyl for post-cesarean section pain relief
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2014 Patient-controlled epidural Levobupicvacaine with or without Fentanyl for post-cesarean section pain relief
More informationIs There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
More informationNalbuphine vs. chlorpheniramine in reducing intrathecal opioidinduced pruritus in parturients undergoing lower-segment caesarean section
Original Article Brunei Int Med J. 2012; 8 (3): 128-134 Nalbuphine vs. chlorpheniramine in reducing intrathecal opioidinduced pruritus in parturients undergoing lower-segment caesarean section Salimi MOHD
More informationPROPOFOL VERSUS PLACEBO FOR PREVENTION OF EMESIS DURING SPINAL ANAESTHESIA
PROPOFOL VERSUS PLACEBO FOR PREVENTION OF EMESIS DURING SPINAL ANAESTHESIA Dr. Amir M. Khudadad Boujan School of Medicine, University of Sulaimani / Iraq Abstract Background: Spinal anesthesia has been
More informationT. Sahoo, C. SenDasgupta, A. Goswami, A. Hazra Department of Anaesthesiology, Institute of Post Graduate Medical Education & Research, Kolkata, India
International Journal of Obstetric Anesthesia (2012) 21, 24 28 0959-289X/$ - see front matter c 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijoa.2011.08.002 ORIGINAL ARTICLE www.obstetanesthesia.com
More informationSCIENTIFIC ARTICLES. Wirzafeldi Sawi * and Choy YC ** Abstract
SCIENTIFIC ARTICLES A COMPARATIVE STUDY OF POST OPERATIVE ANALGESIA, SIDE EFFECTS PROFILE AND PATIENT SATISFACTION USING INTRATHECAL FENTANYL WITH AND WITHOUT MORPHINE 0.1 MG IN CAESAREAN SECTION Wirzafeldi
More informationFactors in patient dissatisfaction and refusal regarding spinal anesthesia
Clinical Research Article Korean J Anesthesiol 2010 October 59(4): 260-264 DOI: 10.4097/kjae.2010.59.4.260 Factors in patient dissatisfaction and refusal regarding spinal anesthesia Won Ji Rhee, Chan Jong
More informationOBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section
British Journal of Anaesthesia 98 (6): 792 6 (2007) doi:10.1093/bja/aem101 Advance Access publication May 3, 2007 OBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective
More informationLow-dose Granisetron for the Prevention of Postoperative Nausea and Vomiting
Low-dose Granisetron for the Prevention of Postoperative Nausea and Vomiting John D. Bridges, BS (Pharm)* Cindy B. Nettle, PharmD* Vijaya J. Dugirrala MD Katie J. Suda, PharmD Kevin W. Garey, PharmD *Baptist
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationAntiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia
British Journal of Anaesthesia 94 (6): 835 9 (2005) doi:10.1093/bja/aei137 Advance Access publication April 15, 2005 Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous
More informationIntrathecal Meperidine for Prevention of Shivering During Transurethral Resection of Prostate
Endourology and Stone Disease Intrathecal Meperidine for Prevention of Shivering During Transurethral Resection of Prostate Maryam Davoudi, 1 Seyed Habib Mousavi-Bahar, 2 Afshin Farhanchi 1 Keywords: transurethral
More informationPrevention CINV (highly emetogenic) Prevention PONV
Reviews/Evaluations 5-Hydroxytryptamine3 (5-HT3) Receptor Antagonists Generic Name Brand Name Manufacturer Dolasetron Anzemet Aventis Granisetron Kytril Roche Ondansetron Zofran GlaxoSmithKline I. FDA
More informationGeneral Anesthesia. My goal in general anesthesia is to stop all of these in the picture above (motor reflexes, pain and autonomic reflexes).
General Anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia and unconscious reflexes, while causing muscle relaxation and suppression of undesirable
More informationOBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
British Journal of Anaesthesia 98 (2): 241 5 (2007) doi:10.1093/bja/ael346 Advance Access publication January 8, 2007 OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
More informationResearch and Reviews: Journal of Medical and Health Sciences
Research and Reviews: Journal of Medical and Health Sciences Evaluation of Epidural Clonidine for Postoperative Pain Relief. Mukesh I Shukla, Ajay Rathod, Swathi N*, Jayesh Kamat, Pramod Sarwa, and Vishal
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationEfficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting
European Review for Medical and Pharmacological Sciences 2001; 5: 59-63 Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane
More informationLOW CONCENTRATION LIDOCAINE (0.5%) BOLUS EPIDURALLY CAN INITIATE FAST-ONSET, EFFECTIVE AND SAFE ANALGESIA FOR EARLY STAGE LABOR
LOW CONCENTRATION LIDOCAINE (0.5%) BOLUS EPIDURALLY CAN INITIATE FAST-ONSET, EFFECTIVE AND SAFE ANALGESIA FOR EARLY STAGE LABOR Henry Liu * 1,2, Shanglong Yao **1, Frank Rosinia *2 Abstract There is no
More informationKayalvizhi 1, J. Radhika 1* Original Research Article. Abstract
Original Research Article Comparative evaluation of safety and efficacy of epidural bupivacaine with morphine and ketamine vs epidural bupivacaine with morphine alone for postoperative analgesia Kayalvizhi
More informationThe Effect of Morphine on the Incidence of Postoperative Nausea and Vomiting after Strabismus Surgery with Propofol
2017 jpc.tums.ac.ir The Effect of Morphine on the Incidence of Postoperative Nausea and Vomiting after Strabismus Surgery with Propofol Mojtaba Rahimi Varposhti 1, Darioush Moradi Farsani 1*, Masoud Fouladgar
More informationAnesthesia for Total Hip and Knee Arthroplasty
Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++
More informationAlizaprideand ondansetronin the prevention of postoperative nausea and vomiting: a prospective, randomized, double-blind, placebocontrolled
Alizaprideand ondansetronin the prevention of postoperative nausea and vomiting: a prospective, randomized, double-blind, placebocontrolled trial. M. Smets N. Van Langenhove G. Dewinter Vrijdagochtendkrans22
More informationCHA Gumi Medical Center, CHA University, Gumi, Korea
Anesth Pain Med 2014; 9: 65-69 Clinical Research Comparison of 0.5% ropivacaine with fentanyl and 0.75% ropivacaine used in extension of a preexisting labor epidural for emergency cesarean section: retrospective
More informationA Qualitative and Quantitative Systematic Review of Randomized Controlled Trials
1919 REVIEW ARTICLE Dennis M. Fisher, M.D., Editor Anesthesiology 1999; 91:1919 27 1999 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Intraoperative and Analgesic Efficacy
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationBritish Journal of Anaesthesia 97 (3): (2006) doi: /bja/ael182 Advance Access publication July 21, 2006
British Journal of Anaesthesia 97 (3): 365 70 (2006) doi:10.1093/bja/ael182 Advance Access publication July 21, 2006 The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative
More informationCesarean delivery is a common intervention performed
Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study Manon Lalmand, MD,* Madeleine Wilwerth,
More informationCesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors
Cesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors Cristian Arzola MD MSc Department of Anesthesia and Pain Management Mount Sinai Hospital and University of
More informationReview Article The effects of prophylactic ondansetron on fentanyl-induced pruritus: a meta-analysis
Int J Clin Exp Med 2016;9(10):18834-18843 www.ijcem.com /ISSN:1940-5901/IJCEM0029283 Review Article The effects of prophylactic ondansetron on fentanyl-induced pruritus: a meta-analysis Chengmao Zhou 1*,
More informationComparision of Intravenous Bolus Phenylephrine and Ephedrine for Prevention of Post Spinal Hypotension in Cesarean Sections
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 7 Ver. II (July. 2015), PP 99-103 www.iosrjournals.org Comparision of Intravenous Bolus Phenylephrine
More informationDoes Granisetron Pretreatment Relieve Pain Due to Propofol Injection?
American Journal of Advanced Drug Delivery www.ajadd.co.uk Original Article Does Granisetron Pretreatment Relieve Pain Due to Propofol Injection? Vijaya Sai and Shaila S. Kamath* Department of anesthesiology,
More informationPain relief after cesarean section: Oral methadone vs. intramuscular pethidine
Original Article Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine Azar Danesh Shahraki, 1 Mitra Jabalameli, 2 Somayeh Ghaedi 3 1 Associate Professor, Department of Obstetrics
More informationInnovative Approaches and New Technology to Gain Access
Innovative Approaches and New Technology to Gain Access The following is intended only for presentation to the Reimbursement and Access 2017 audience, August 17, 2017. This information is not for promotional
More informationThe Comparison Effect of Preoperative Ondansetron and Metoclopramide in Reducing Nausea and Vomitting after Loparoscopic Cholecystectomy
Journal of Ardabil University of Medical Sciences Vol.3, No.2, Summer 203, Pages 55-63 The Comparison Effect of Preoperative Ondansetron and Metoclopramide in Reducing Nausea and Vomitting after Loparoscopic
More informationManagement of Postoperative Nausea and Vomiting in Ambulatory Surgery The Big Little Problem
Management of Postoperative Nausea and Vomiting in Ambulatory Surgery The Big Little Problem Mary Keyes, MD KEYWORDS Postoperative nausea and vomiting PONV prophylaxis PONV in ambulatory surgery KEY POINTS
More informationEfficacy Of Propofol In Preventing Postoperative Nausea And Vomiting (PONV): Single Blind Randomized Control Study
ISPUB.COM The Internet Journal of Anesthesiology Volume 7 Number 1 Efficacy Of Propofol In Preventing Postoperative Nausea And Vomiting (PONV): Single Blind Randomized Control Study Ramanathan, Augustus,
More information