---

Background & Objective: One of the post-operational problems in the cesarean-section is ileus symptoms and the starting point of taking the liquid diet. Some controversy are about this procedures. This study was done to evaluate the rate of ileus symptoms of women who are offered oral hydration shortly after cesarean delivery. Materials & Methods: This study involved 276 women delivered by cesarean under general anesthesia that had no previous cesarean or laparotomy and indisposing and their operations had not been exceeded 90 minutes. For these patients a liquid diet for every other day, partly 6 hours and others 12 hours after operation was started. The patients were examined at the time of starting diet and 6 hours later for bowel sound, nausea or vomiting, abdominal distention and gas passage. 138 women were assigned to each procedure. Results: Nausea or vomiting cases in the early fed group, were more than 12 hourly diets (2.2% versus no case) and (12.3% versus 10.9%) but the difference was not statistically significant. The bowel sound in the early fed group were less than 12 hourly starting the diets, (15.2% versus 12.3%) the difference was not statistically significant. The 6 hourly starting of liquid diet had a significant effect in speeding up bowel movements (P<0.05). Conclusion: Early oral hydration after cesarean was well tolerated and it was associated with rapid return of propulsive bowel movements, so to do, this results in better reply to the physiologic request of the patients.

---

Background and Objective: A common complication after general anesthesia is nausea and vomiting followed by different problems such as spasm, hypoxia and pulmonary aspiration. This complication is more common in patients with full stomach, Eye injury, head trauma, cesarean and laparoscopy. Propofol and metoclopramide are two common drugs to prevent nausea and vomiting after operation. On the other hand adding dexamethasone to the above drug, has an important effect on decreasing nausea and vomiting. In this study, the effect propofol and metoclopramide associated with dexamethasone on nausea and vomiting after operation was investigated.

Materials and Methods: In this clinical trial study, 100 patients with ASA I, II classes, aged 16-60 years with selective orthopedic surgery randomly have divided into two groups. In group one, 48 patients received metoclopramide (10mg) with dexamethasone (8mg) and in group two, 52 patients received propofol (20mg) with dexamethasone (8mg), five minutes before the end of operation. Prevalence of nausea and vomiting in both groups was considered after 4 hours and results were analyzed by Chi-Square, t-student and Fisher exact tests.

Results: The rate of nausea in group 1 and 2 was 35.4% and 11.5% respectivly (P<0.05). The rate of vomiting was 27.7% and 7.7% in group 1 and 2 respectivly (P<0.05).

Conclusion: This study showed that the antiemetic effect of propofol with dexamethasone is more effective to prevent nausea and vomiting than metoclopromide with dexamethasone.

---

Background and Objective: Using of laryngeal mask air way (LMA) was recommended for air way management in short duration elective surgeries. One of its side effects is the increasing of secretion of air way and subsequently laryngospasm. Anticholinergic drugs (hyoscine NBB and atropine) have been administrated to reduce of these side effects. This study was carried out to compare the atropin and hyoscine n-butylbromide (NBB) on hemodynamic and nausea and vomiting in anesthesia with laryngeal mask air way. Materials and Methods: In this randomized double- blind control trials, 100 patients (20-50 years) with class 1 and class 2 of Anesthesia, have been operated less than one hour under general anesthesia with LMA during 2007-08 in Beheshti hospital. These patients were divided to 2 groups every other one randomly with equal persons. After controlling the base of heart rate (HR) and mean arterial pressure (MAP), both groups was administrated to premed according weight. Then 0.5mg/5ml atropine to the first group and 10mg/5ml hyoscine NBB (Buscopan) to the second group was injected and hemodynamic was controlled after two minutes. Anesthesia with thiopental sodium was induced and LMA was inserted. Then hemodynamic was controlled during the time. The amount of secretions of air way was investigated according to the numbers of suction at the end of surgery and after removing of LMA. The severity of postoperative nausea and vomiting was assessed with attention to need of patients to antiemetic until 6 hours. Data was analyzed statistically. Results: Antiemetic effect of atropin and hyoscine n-butylbromide (NBB) was similar. With mild secretions, moderate and sever antisialague effect of hyoscine NBB was 80%, 18% and 2% and in atropine group was 72%, 22% and 6% retrospectively. Heart rate increase (less of 20%) without rising MAP was obsered in two groups. Conclusion: This study showed that the effects of hyoscine and atropine in decreasing airway secretions, nausea and vomiting is similar.

---

Background and Objective: Nausea and vomiting are the most frequent complications in the first trimester of pregnancy. Herbal medicine is among the traditional effective treatments. Ginger and Chamomile are hypothesized to be useful in decreasing the signs. This study was done to determine the effect of Ginger and Chamomile capsules on nausea and vomiting in pregnancy.

Materials and Methods: This triple-blind randomized placebo-controlled trial was carried out on 105 pregnant women in 6-16 weeks of gestational age with a mild to moderate nausea and vomiting, whome referred to the prenatal care clinic in Dezyani hospital and health centers, Gorgan, Northern Iran during 2009-10. Rhodes index questionnaire had been given to all participants to be completed before bed-time for two weeks. In the first week no intervention was done and prescribing the capsules was started the following week. Subjects randomly divided into 3 groups: In group 1, ginger capsules were consumped twice a day for one week, in group 2 twice daily chamomile capsule and in placebo group, glucose capsule was prescribed. Scores were calculated and all data were entered into the SPSS-16 software, analysis was done using variance analysis, Will-Cockson, paired T and Fisher-exact tests.

Results: The mean of Rhodes index before intervention in plasbo, Ginger and Chamomile groups were 12.71±5.88, 10.42±0.76 and 11.19±5.51, respectively. Also, the mean of Rhodes index after intervention in plasbo, Ginger and Chamomile groups were 11.47±6.43, 7.28±3.74 and 5.73±4.32, respectively (P<0.05). Bonferroni test indicated that there is no difference about scor chang (after and before) between Ginger and Chamomile and Ginger and plasbo, but this difference was significant between Chamomile and plasbo group (P<0.05).

Conclusion: This study showed that Chamomile capsule was more effective on nausea and vomiting during pregnancy compared to Ginger.

---

Background and Objective: Post-operative nausea vomiting (PONV) and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration. Materials and Methods: This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation (CV) group and anesthesia continued with mechanical ventilation. For the patients of the second group (spontaneous respiration/SR), after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N2O/O2. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student’s t-test, chi-square and Fisher’s exact tests. Results: Post-operative nausea was non significantly higher in CV group (8%) than SR (6.52%). The rate of vomiting was higher in CV (16%) as compared to SR group (2.17%). (P<0.001, RR=8.57, CI: 1.91-38.41). The rate of laryngospasm at the end of the surgery was higher in CV group (15.21%) as compared to SR group (26%) (P<0.02, RR= 0.94, CI: 0.05-1.77). The rate of excessive discharge at the end of the surgery was significantly higher in CV group (52%) in comparison with SR group (11.95%) (P<0.001, RR=0.94, CI: 0.05-1.77). Conclusion: This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants.

---

Background and Objective: Nausea and vomiting are common complications after surgery which creates spasm, hypoxia and pulmonary aspiration. This study was done to determine the effect of ondansetrone, metoclopramide associated with dexamethasone on postoperative nausea and vomiting in cholecystectomy surgery using Laparoscopic method. Methods: In this double blind clinical trial study, 100 patients with ASA class I and II undergoing laparoscopic cholecystectomy divided randomly into two groups. The patients in the first group were received metoclopramide (10mg/kg/bw) with dexamethasone (8mg/kg/bw) and the second group were received ondansetron (4mg/kg/bw) with dexamethasone (8mg/kg/bw) intravenously 5 min before the final stage of surgery. Premedication and induction of anesthesia in patients were equal 5 minutes to 4 hours after surgery, postoperative nausea and vomiting were recorded for each patient. Results: The rate of nausea in the first and the second groups were recorded 38% and 28%, respectively. The rate of vomiting in the first and the second groups were recorded 30% and 16%, respectively. These values were not significant. Conclusion: Ondansetron with dexamethasone non significantly reduced postoperative nausea and vomiting after laparoscopic cholecystectomy in comparison with metoclopramide with dexamethasone.