Articles Vol. 66 No. CĐ13- HNKH Gây mê Hồi sức 25/09/2025

37. EVALUATION OF THE EFFECTIVENESS OF MIDAZOLAM COMBINED WITH DEXAMETHASONE IN PREVENTING NAUSEA AND VOMITING AFTER SPINAL ANESTHESIA FOR CESAREAN SECTION

Le Thanh Huyen1, Nguyen Duc Lam2,3, Mai Trong Hung3, Tran Van Cuong3
1 Bệnh viện Trung ương Thái Nguyên
2 Trường Đại học Y Hà Nội
3 Bệnh viện Phụ sản Hà Nội
Corresponding author: drhuyenle187@gmail.com
DOI: 10.52163/yhc.v66iCD13.3203
27 Views
19 Downloads
Abstract

Objective: To evaluate and compare the efficacy of Midazolam combined with Dexamethasone versus Dexamethasone alone in preventing postoperative nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia.

Object and methods: A randomized, controlled, single-blind clinical trial with a parallel-group design was conducted on 80 parturients undergoing elective cesarean section under spinal anesthesia at Thai Nguyen National Hospital from April 2025 to July 2025. Participants were randomly assigned to two groups: group D received 8 mg of intravenous Dexamethasone immediately before spinal anesthesia; group MD received 8 mg of intravenous Dexamethasone immediately before spinal anesthesia and 0.03 mg/kg of intravenous Midazolam immediately after umbilical cord clamping.

Results: The incidence of postoperative nausea was significantly higher in group D (20%) compared to group MD (7.5%) (p < 0.05). Postoperative nausea and vomiting within the first 6 hours postoperatively was also significantly more frequent in group D (37.5%) compared to group MD (12,5%). Furthermore, the severity of postoperative nausea and vomiting, assessed using the Klockgether-Radke scale, was significantly lower in group MD across all time points.

Conclusion: The combination of Midazolam and Dexamethasone significantly reduces the incidence and severity of postoperative nausea and vomiting following cesarean section under spinal anesthesia, particularly within the first 6 hours postoperatively.

References
[1]
Balki M, Carvalho J.C.A. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. International Journal of Obstetric Anesthesia, 2005, 14 (3): 230-241. doi:10.1016/j.ijoa.2004.12.004. Google Scholar
[2]
Takada K, Murai T, Kanayama T, Koshikawa N. Effects of Midazolam and flunitrazepam on the release of dopamine from rat striatum measured by in vivo microdialysis. British Journal of Anaesthesia, 1993, 70 (2): 181-185. doi:10.1093/bja/70.2.181. Google Scholar
[3]
Florio T.D. The Use of Midazolam for Persistent Postoperative Nausea and Vomiting. Anaesth Intensive Care, 1992, 20 (3): 383-386. doi:10.1177/0310057X9202000324. Google Scholar
[4]
De Oliveira G.S, Castro-Alves L.J.S, Ahmad S, Kendall M.C, McCarthy R.J. Dexamethasone to Prevent Postoperative Nausea and Vomiting: An Updated Meta-Analysis of Randomized Controlled Trials. Anesthesia & Analgesia, 2013, 116 (1): 58-74. doi:10.1213/ANE.0b013e31826f0a0a. Google Scholar
[5]
Sekhavat L, Davar R, Behdad S. Efficacy of prophylactic Dexamethasone in prevention of postoperative nausea and vomiting. J Epidemiol Glob Health, 2015, 5 (2): 175-179. doi:10.1016/j.jegh.2014.07.004. Google Scholar
[6]
​Statement on ASA Physical Status Classification System. Accessed August 4, 2025. https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system. Google Scholar
[7]
Yeo J, Jung J, Ryu T, Jeon Y.H, Kim S, Baek W. Antiemetic Efficacy of Dexamethasone Combined with Midazolam after Middle Ear Surgery. Otolaryngol--head neck surg, 2009, 141 (6): 684-688. doi:10.1016/j.otohns.2009.09.014. Google Scholar
[8]
Vũ Văn Hiệp, Nguyễn Đức Lam. Đánh giá tác dụng dự phòng nôn và buồn nôn của Ondansetron, Dexamethason và Metoclopramid trong và sau mổ lấy thai dưới gây tê tủy sống. Tạp chí Nghiên cứu Y học, 2020, 133: 139-145. Google Scholar
[9]
Phạm Thị Anh Tú, Công Quyết Thắng, Lưu Quang Thùy. Đánh giá hiệu quả dự phòng nôn, buồn nôn bằng Dexamethson 8 mg và Ondasetron 4 mg trong gây tê tủy sống bằng Bupivacain và Morphin trong mổ lấy thai. Tạp chí Y học Việt Nam, 2021, 500 (1). doi:https://doi.org/10.51298/vmj.v500i1.291. Google Scholar
[10]
Pantos M.M, Kennedy D.R, Nemec E.C. Remimazolam: A Novel Option for Procedural Sedation in High Risk Patients. Journal of Pharmacy Practice, 2023, 36 (1): 149-154. doi:10.1177/08971900211027303. Google Scholar
[11]
El-Deeb A, Abd el motlb E. Prophylactic multimodal antiemetic in women undergoing cesarean section under spinal anesthesia. Egyptian Journal of Anaesthesia, 2011, 27 (2): 107-111. doi:10.1016/j.egja.2011.04.003. Google Scholar
[12]
Lee Y, Huang P.K, Row P.H. A comparative study of Dexamethasone plus Midazolam, ondansetron, or saline as prophylactic antiemetic therapy in patients at high risk of postoperative nausea and vomiting: A-610. European Journal of Anaesthesiology. EJA, 2006, 23: 158. Google Scholar