Kjaer Klaus, Comerford Michele, Kondilis Linda, DiMaria Lauren, Abramovitz Sharon, Kiselev Michael, Samuels Jon, Gadalla Farida, Leighton Barbara L
Department of Anesthesiology, Weill Medical College of Cornell University, 525 E 68th Street, M-325, New York, NY 10021, USA.
Can J Anaesth. 2006 Aug;53(8):776-80. doi: 10.1007/BF03022794.
Historically, aspiration of gastric contents with subsequent pneumonia was a major cause of anesthesia-related maternal mortality. Before elective Cesarean delivery, gastric fluid can be neutralized with histamine-2 blockers or with oral sodium citrate. Although sodium citrate is commonly used, many patients dislike its taste. We designed this study to determine whether or not patients are more likely to experience nausea during Cesarean delivery when sodium citrate is administered preoperatively.
One hundred and twenty-three healthy women carrying a singleton fetus and scheduled for elective Cesarean delivery under spinal anesthesia were randomized to receive either sodium citrate 30 mL p.o. and saline 2 mL i.v. (sodium citrate group), or water 30 mL p.o. and famotidine 20 mg i.v. (famotidine group). Spinal anesthesia consisted of 1.6 mL of 0.75% bupivacaine (12 mg), fentanyl 20 microg, and preservative-free morphine 200 microg. Patients were asked to rate the degree of nausea present at one and five minutes after spinal placement, at the time of uterine exteriorization, and upon arrival to the recovery room. At each time point, the patient's systolic blood pressure and heart rate were recorded.
At all recorded intervals, the average degree of nausea was greater in the sodium citrate group compared to the famotidine group. The frequency of nausea was also greater in the sodium citrate group compared with the famotidine group (37% vs 14% respectively, P < 0.05) five minutes after establishment of spinal anesthesia. The frequencies of nausea were not significantly different between groups at other time periods.
Nausea is more common during Cesarean delivery in women who receive oral sodium citrate rather than i.v. famotidine for aspiration prophylaxis.
在历史上，胃内容物误吸继而引发肺炎是麻醉相关孕产妇死亡的主要原因。在择期剖宫产术前，可用组胺-2受体阻滞剂或口服柠檬酸钠来中和胃液。尽管柠檬酸钠常用，但许多患者不喜欢其味道。我们开展本研究以确定术前给予柠檬酸钠的患者在剖宫产术中是否更易出现恶心。
123例单胎妊娠且计划在脊髓麻醉下行择期剖宫产的健康女性被随机分为两组，分别口服30 mL柠檬酸钠溶液并静脉注射2 mL生理盐水（柠檬酸钠组），或口服30 mL水并静脉注射20 mg法莫替丁（法莫替丁组）。脊髓麻醉采用1.6 mL 0.75%布比卡因（12 mg）、20 μg芬太尼和200 μg无防腐剂吗啡。要求患者对脊髓麻醉置管后1分钟和5分钟、子宫取出时以及进入恢复室时的恶心程度进行评分。在每个时间点，记录患者的收缩压和心率。
在所有记录的时间段内，柠檬酸钠组的平均恶心程度均高于法莫替丁组。脊髓麻醉建立5分钟后，柠檬酸钠组的恶心发生率也高于法莫替丁组（分别为37%和14%，P<0.05）。在其他时间段，两组间的恶心发生率无显著差异。
在剖宫产术中，接受口服柠檬酸钠而非静脉注射法莫替丁预防误吸的女性恶心更为常见。
