Nausea and vomiting during Caesarean section — a reply

We are grateful to Dr Kar and associates for their interest in our article. We stated in the Methods section of our article [1] ‘To prevent hypotension, ephedrine was infused continuously (50 mg in 250 ml saline) [2] When it (hypotension) occurred, it was treated by additional fluids and intravenous increments (5–10 mg) of ephedrine’. Thus, we attempted to treat hypotension in a similar manner to the suggestion of Dr Kar. In fact, we initiated this method of therapy in 1982 [2]. Although we recorded the blood pressure every 5 min, it was measured every 30 s using an automatic noninvasive machine (Vitalert 3200 by Driger Co.) until the fetus was delivered. This is our routine. The reason is that the significant and rapid changes in blood pressure following spinal anaesthesia and ephedrine administration have important impacts on the fetal outcome. Following delivery, the frequency of blood pressure measurement depended on the haemodynamic stability of the patient, but was performed at least every 2–3 min. We do not have a clear or definite answer to the reason/s for the higher incidence of nausea and vomiting in this study [1] compared with our previous study [2] or to those of Dr Kar. It may have been due to the fact that we were looking for and recording every short episode or minor incident of nausea, vomiting or retching. The lower socio-economic condition and the heavier weight of the present population could have contributed to the higher incidence. In fact, when we tested the data we have on file for this study, there was a significant correlation between vomiting and body weight (p = 0.0026). Regarding the cost of anti-emetics, although important, it was not the purpose of our study. However, this brings important philosophical questions. Do we deny an expensive drug the right to be investigated? Do we have to ask the manufacturer to let us know their intention of pricing a drug before we study it? We feel the answer to both questions is no. The pharmacological effects and clinical use of drugs should not be overshadowed by cost. Initially, a patented drug has a high price, but it substantially decreases after the expiration of this privilege.