Amir Murad Khudadad a and Bafrin Samad Aghawaise b

a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 

b Sulaimani Surgical Teaching Hospital.


Submitted: 25/2/2019; Accepted: 5/9/2019; Published: 21/9/2019

DOI Link: https://doi.org/10.17656/jsmc.10215 



Nausea and vomiting is a common complication in parturients with cesarean delivery under spinal anesthesia it may causes significant distress to the patient and increases the chance of aspiration pneumonitis, it also affects the surgical procedure. Many drugs have been used to prevent this complication but none proved to be effective to abolish it completely.


Subhypnotic dose of Midazolam or Propofol were evaluated to prevent intraoperative nausea and vomiting during elective cesarean section under spinal anesthesia.


This study is a randomized control clinical trial, after local ethical committee approval A 93 consenting (ASAII ) parturients, who underwent spinal anesthesia for caesarean section were divided randomly into three groups received Propofol (20 milligram bolus and 0.1 milligram /kilogram/hour by infusion immediately after the bolus dose, 30 parturients ), Midazolam (1 milligram bolus and 1 milligram/hour by infusion after bolus dose, 31 parturients ), and placebo (saline, 32 parturients ) intravenously after umbilical cord clamping. Bupivacaine 0.5% (12.5-15 milligram) used for spinal anesthesia. Intraoperative and post delivery emetic episodes were recorded.


The incidence of nausea and vomiting was significantly less in the propofol and Midazolam groups in compared to placebo group. There was insignificant difference between Propofol and Midazolam group in postoperative nausea and vomiting (P = 0.616) and there were no significant hemodynamic changes in all the groups. 


The use of Propofol is as effective as Midazolam in decreasing nausea and vomiting during Caesarean section under spinal anesthesia.


Propofol, Midazolam, Nausea and vomiting, Caesarean section, Spinal anesthesia.


1. P, Hannele H. Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience. Reg Anesth. 1993; 18(2):128–31.

2. Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Juhani T Int J Obstet Anesth. 2005; 14(3):230–41. 

3. Mishriky BM, Habib AS. Metoclopramide for nausea and vomit-ing prophylaxis during and after Caesarean delivery: a system-atic review and meta-analysis. Br J Anaesth. 2012; 108(3):374–83. 

4. Santos A, Datta S. Prophylactic use of droperidol for control of nausea and vomiting during spinal anesthesia for cesarean sec-tion. Anesth Analg. 1984; 63(1):85–7. 

5. Chestnut D H, Vandewalker G E, Owen C L. Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section . Anesthesiology 1997; 66: 563–566.

6. John F. Butterworth. David C. Mackey. John D. Wasnick. Morgan and Mikhails Clinical Anesthesiology. 5th ed, 2013; 175-186.

7. Ronald D. miller,lars i. eriksson,lee a. fleisher,Jeanine p.wiener-kronish,William l. Young. Miller’s anesthesia. 7th edition.2010, 723-728,734-740.

8. Hugh c.hemmings jr.talmage d.egan Pharmacology and physiology for anaesthesia (foundations and clinical application) 2013. 29:515-520. ISBN:9781437716795

9. Shergill AK, Ben-Menachem T, Chandrasekhara V . Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012; 76:18-24. PMID: 22579258

10. Vargo JJ, Delegge MH, Feld AD. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012; 143:e18-41. PMID: 22624720

11. Kraus GB, Giebner M, Palackal R. The Prevention of postoperative nausea and vomiting following cesarean section. Anaesthetist- 1991; 40:92:95.

12. Bigler D, Hjortso NC, Edstrom H, Comparative effects of intrathecal bupivacaine and tetracaine on analgesia, cardiovascular function and plasma catecholamines. Acta Anaesthesiol Scand 1986; 30:199–203.

13. Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl is superior to intravenous ondansetron for the prevention of perioperative nausea during caesarean delivery with spinal anaesthesia . Anesth Analg 2000; 90: 1162-66.

14. Seyedhejazi M, Eydi M, Ghojazadeh M, Nejati A, Ghabili K, Golzari SE, et al. Propofol for laryngeal mask airway insertion in children: Effect of two different doses. Saudi J Anaesth. 2013; 7(3):266–9. 

15. Rodola F. Midazolam as an anti-emetic. Eur Rev Med Pharmacol Sci. 2006;10(3):121–6 

16. Sousan Rasooli 1; Farnaz Moslemi 1; Arash Khaki 2, Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section Anesth Pain Med. 2014 October; 4(4): e19384.

17. Samimi S, Davari F, Sadeghi S. Prevention of Postoperative Nau-sea and Vomiting by Administration of Subhypnotic doses of Propofol and Midazolam during Spinal Anesthesia for Cesarean Section. Reproduc Health J. 2010; 4:175–8. 

18. Tarhan O, Canbay O, Celebi N, Uzun S, Sahin A, Coskun F, et al. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section. Minerva Anestesiol. 2007; 73(12):629–33. 

19. Numazaki M, Fujii Y. Subhypnotic dose of propofol for the pre-vention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesth Intensive Care. 2000; 28(3):262–5. 

20. Tramèr M, Moore A, McQuay H Propofol anesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies Br J Anaesth.1997 Mar; 78(3):247-55.

21. Fujii Y, Itakura M Low-dose propofol to prevent nausea  and vomiting after laparoscopic surgery. Int J Gynaecol Obstet. 2009 Jul; 106(1):50-2. doi: 10.1016/j.ijgo.2009.03.008. Epub 2009 Apr 9.

22. Naghibi K, Kashefi P, Azarnoush H, Zabihi P, Prevention of postoperative nausea and vomiting a sub hypnotic  dose  of  Propofol  in patients undergoing lower abdominal surgery: A prospective,  randomized , double-blind study. Adv Biomed Res. 2015 Feb 11; 4:35. Doi: 10.4103/2277-9175.151239. e Collection 2015.

23. Unal Y1, Ozsoylar O, Arslan M, Sarigüney D, Akçabay M Comparison of the efficacy of propofol  and metoclopramide in preventing postoperative nausea and vomiting after middle ear surgery Saudi Med J. 2009 Jun;30(6):778-82.

24. Yerrramsetti Atchyutha Ramaiah , B Vishnu Mahesh Babu , B Soubhagya Lakshmi , Chandra Mouli , Prevention of Post-operative Nausea and Vomiting with a Sub-hypnotic Dose of Propofol Combined with Dexamethasone in Patients Undergoing Laparoscopic Cholecystectomy Surgeries: A Prospective Randomized Controlled Study International Journal of Scientific Study . February 2015. Vol 2. Issue 11.

25. Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. Anaesth Intensive Care. 1992; 20(3):383–6. 

26. Fujii Y, Itakura M A prospective, randomized, double-blind, placebo-controlled study to assess the antiemetic effects of midazolam on post operative nausea and vomiting in women undergoing laparoscopic gynecologic surgery. Clin Ther. 2010 Aug; 32(9):1633-7. doi: 10.1016/j.clinthera.2010.08.005.

 27. Nagizadeh S, Azari S, Mohammady F, Ebrahimpour mirza rezaei Sehhati F. Maternal Satisfaction about Prenatal and postnatal Cares in Vaginal and Cesarean Section Delivery at Teaching and Non-teaching Hospitals of Tabriz/Iran. Int J Women’s Health Repro-duction Sci. 2014; 2(3):146–54.

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