Effect of Using Midazolam and Propofol in Low Doses for Intraoperative Nausea and Vomiting Prevention in Pregnant Women Underwent Cesarean Section under Regional Anesthesia

Aim: To investigate if and how severe intraoperative nausea and vomiting occur following elective cesarean sections performed under spinal anesthesia using sub-hypnotic dosages of midazolam and propofol. Study Design: Clinical trial. Methodology:  The current study was conducted at the Gynecology and Obstetrics Department of a Teaching Hospital in Baghdad, Iraq. The study included 90 full-term pregnant women with single viable fetuses who underwent elective C/S by spinal anesthesia and were randomly assigned to one of three groups: group A included 30 women who received propofol, group B included 30 women who received midazolam, and Group C included 30 women who received placebo. The Bellville scoring score was used to assess nausea and vomiting. The Richmond Agitation Sedation Score (RASS) was used to assess sedation intraoperatively. Results: Patients in group C had the highest prevalence of nausea and vomiting (56.7%), which was significantly different from groups A (16.7%, P=0.001) and B (13.3%, P=0.001); however, there was no statistically significant difference between groups A and B (P= 0.717). The group B patients had the highest prevalence of drowsiness (20%), which was substantially different from group C (3.3%, P=0.044), whereas there were no statistically significant differences between groups A and B (P= 0.278) or A and C (P= 0.3). Conclusion: Low doses of midazolam or propofol administered after cesarean section (after the umbilical cord has been clamped) can lessen intraoperative nausea and vomiting without significantly lowering blood pressure or heart rate, with midazolam being more effective than propofol in this regard.