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Oral sodium citrate increases nausea amongst elective Cesarean delivery patients

Le citrate de sodium oral augmente les nausées pendant la césarienne réglée]

Abstract

Purpose

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.

Methods

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 mLpo and saline 2 mLiv (sodium citrate group), or water 30 mLpo and famotidine 20 mgiv (famotidine group). Spinal anesthesia consisted of 1.6 mL of 0.75% bupivacaine (12 mg), fentanyl 20 µg, and preservative-free morphine 200 µg. 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.

Results

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.

Conclusion

Nausea is more common during Cesarean delivery in women who receive oral sodium citrate rather thaniv famotidine for aspiration prophylaxis.

Résumé

Objectif

Historiquement, l’aspiration du contenu gastrique, et une pneumonie subséquente, a été la cause majeure de mortalité maternelle reliée à l’anesthésie. Avant la césarienne réglée, le liquide stomacal peut être neutralisé avec des inhibiteurs H2 de l’histamine ou du citrate de sodium oral. Le citrate de sodium est couramment utilisé, mais de nombreuses patientes n’en aiment le goût. Nous voulions vérifier si les patientes avaient plus de nausées, ou non, pendant la césarienne précédée de l’administration de citrate de sodium.

Méthode

Cent vingt-trois femmes saines porteuses d’un seul enfant et devant subir une césarienne réglée sous rachianesthésie ont été réparties au hasard et ont reçu, soit 30 mL po de citrate de sodium et 2 mL de solution salée iv, soit 30 mL d’eau po et 20 mg de famotidine iv. La rachianesthésie consistait en 1,6 mL de bupivacaïne à 0,75 % (12 mg), 20 µg de fentanyl et 200 µg de morphine sans agent de conservation. On a demandé aux patientes de préciser le degré de nausées à une et à cinq minutes après l’administration de l’anesthésie, au moment de l’extériorisation utérine et à l’arrivée en salle de réveil. Lors de chaque mesure, la tension artérielle systolique et la fréquence cardiaque étaient enregistrées.

Résultats

Le degré moyen des nausées a été plus élevé avec le citrate de sodium comparé au famotidine à chaque intervalle de mesure. La fréquence des nausées a aussi été plus grande avec le citrate de sodium qu’avec le famotidine (37%vs 14% respectivement, P < 0,05) cinq minutes après l’administration de la rachianesthésie. La fréquence des nausées n’a pas été significativement différente entre les groupes aux autres temps de mesure.

Conclusion

Les nausées sont plus fréquentes pendant la césarienne chez les femmes qui reçoivent du citrate de sodium oral plutôt que du famotidine iv pour prévenir l’aspiration.

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Author information

Correspondence to Klaus Kjaer or Michele Comerford or Linda Kondilis or Lauren Di Maria or Sharon Abramovitz or Michael Kiselev or Jon Samuels or Farida Gadalla or Barbara L. Leighton.

Additional information

Supported by research funding from the Department of Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA.

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Kjaer, K., Comerford, M., Kondilis, L. et al. Oral sodium citrate increases nausea amongst elective Cesarean delivery patients. Can J Anesth 53, 776–780 (2006). https://doi.org/10.1007/BF03022794

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Keywords

  • Cesarean Delivery
  • Spinal Anesthesia
  • Sodium Citrate
  • Famotidine
  • Elective Cesarean Section