COMPARATIVE STUDY OF METOCLOPRAMIDE AND ONDANSETRON WITH PANTOPRAZOLE IN ELECTIVE CAESEREAN SECTION UNDER SPINAL ANAESTHESIA FOR ASPIRATION PNEUMONITIS PROPHYLAXIS.

Abstract

BACKGROUND- Caesarean delivery, one of the most commonly performed surgical procedure. The choice of anaesthesia is spinal blockade for elective caeserean-section,unless general anaesthesia is specically indicated. Aspiration pneumonitis remains an important cause of morbidity and mortality in anaesthesia practise,particularly in obstetric patients,prophylaxis against it is paramount importance in pre-anaesthetic management. AIMS AND OBJECTIVES- The aim of this study was to compare pH and volume of gastric contents after administration of combination of metoclopramide and pantoprazole versus ondansetron and pantoprazole during elective caesarean section under spinal anaesthesia for prophylaxis against aspiration pneumonitis. METHODS: It is a prospective study where 100 parturient women, ASA 1 and 2 scheduled for elective caesarean section. They were divided into 2 groups: ondansetron(4mg) and pantoprazole(40mg),and metoclopramide(10mg), pantoprazole(40mg) administered intravenously 2hours before surgery. Gastric aspirate was taken in various positions before giving spinal anaesthesia and at the end of operation. Patients at risk were according to criteria of gastric volume more than 0.4ml/kg with pH <2.5. RESULTS:Patients at risk were 7(14%) in metoclopramide group and 1(2%) in ondansetron group before giving spinal anaesthesia(p=0.027) and 6(12%) in metoclopramide group and 0(0%) in ondansetron group at end of operation(p=0.012) . Since p-value was less than 0.05 there was signicant difference between two groups. CONCLUSION: As there was signicant difference between ondansetron and metoclopramide , it is recommended to use ondansetron and pantoprazole for prophylaxis against aspiration pneumonitis.