Effect of Ondansetron on the Occurrence of Hypotension and on Neonatal Parameters during Spinal Anesthesia for Elective Caesarean Section: A Prospective, Randomized, Controlled, Double-Blind Study (original) (raw)
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2021
Introduction Hypotension is one of the most common complications associated with spinal anaesthesia. Maternal hypotension during caesarean section is more dangerous as it can compromise fetal outcome. Serotonin (5-HT3) has been found to induce Bezold Jarisch Reflex (BJR) causing bradycardia and hypotension in background of decreased blood volume. Ondansetron, a serotonin antagonist may play important role in prevention of spinal induced hypotension. The aim of this study is to determine the effect of intravenous ondansetron to prevent spinal induced hypotension during caesarean section. Methods A prospective randomised double blind study was done among singleton parturients scheduled for elective caesarean delivery under spinal anaesthesia from 2 nd July 2020 to 31 st October 2021 in College of Medical Sciences Teaching Hospital. One hundred and thirty patients were randomised by lottery method into two groups (group S and group O) each with 65 patients to receive either 4 mg of intravenous (IV) ondansetron diluted in 10 ml of normal saline or 10 ml of normal saline alone. Various haemodynamic parameters like systolic and diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Spo 2) and vasopressor requirement were compared between the two groups using SPSS 20. Student's t test and chi-square test were used for comparison of parametric and non-parametric data. Results Incidence of hypotension was 28 (43.07%) in saline group and 11 (16.92%) in ondansetron group. There were statistically significant differences in SBP, DBP and MAP at three, six, nine twelve, fifteen and eighteen minutes. Incidence of shivering was 15 (23.07%) in ondansetron while 28 (43.07%) in saline group which was statistically significant. No other benefit of ondansetron was observed in present study. Conclusions Prophylactic administration of IV ondansetron could significantly reduce the incidence of spinal induced hypotension during caesarean section.
2021
Background: Hypotension is one of the most common intra-operative complications associated with spinal anaesthe-sia. Its incidence in caesarean section has been estimated to be as high as 50-60%. Despite fluid preloading, lateral uterine displacement and the use of vasopressor agents. It occurs due to sympathetic block which leads to autonomic nervous system disturbances and a decrease in systemic vascular resistance. This can occur because the level of block must be at least at T4 to ensure adequate analgesia severe hypotension following spinal anaesthesia in caesarean section is a dangerous com-plication. If it is unnoticed or inadequately treated, it can lead to serious maternal or fetal compromise. Aim of Study: To evaluate the effect of two doses of prophylactic ondansetron on spinal anesthesia-induced hypo-tension and bradycardia among patients undergoing elective cesarean deliveries. Patients and Methods: This study was carried out in Ain Shams Hospital Obstetric Theatres fro...
Scholars journal of applied medical sciences, 2022
Original Research Article Introduction: Hypotension and bradycardia following the administration of spinal anesthesia for cesarean section are very common and bear profound detrimental effects both on mother and baby. In our country, a significant proportion of patients undergo cesarean section delivery. Considering the workload and the socioeconomic condition it is often a bad headache for our anesthesiologists to combat post-spinal hypotension. Vasopressor drugs have been widely used to prevent and treat maternal hypotension during cesarean section under spinal anesthesia. A combination of preloading and using vasopressor has maximum efficacy in preventing spinal-induced hypotension but with compromising with some detrimental adverse effects of vasopressor. Amongst vasopressors, ephedrine is widely used but studies found that a higher bolus dose is often required to prevent hypotension and bradycardia. Aim of the study: To find out the efficacy of ondansetron to prevent haemodynamic derrangement in cesarean section under spinal anaesthesia. Methods: This Prospective Randomized Double-Blind Comparative study was conducted at the
Journal of Babol University of Medical Sciences, 2022
Background and Objective: Hypotension and bradycardia are among the common side effects of spinal anesthesia. The effect of ondansetron on the reduction of hypotension and bradycardia caused by spinal anesthesia has been studied considering its antagonistic effect on the Bezold–Jarisch reflex. The present study was conducted to determine the effectiveness of two different doses of intravenous ondansetron on the reduction of the incidence of hypotension and bradycardia among candidates for elective caesarean section under spinal anesthesia. Methods: This double-blind clinical trial was conducted in Shahid Beheshti Hospital in Isfahan in 2020 and included 90 patients aged 18 to 45 years in full-term pregnancy who were candidates for elective caesarean section in three groups of 30. 5 minutes before spinal anesthesia, 6 and 8 mg of ondansetron were injected in the first and second groups, respectively, and normal saline was injected in the third group. Vital signs were examined every 15 minutes during surgery and during recovery, and the incidence of hemodynamic disorders, nausea and vomiting was compared between the three groups. Findings: There was no significant difference between the three groups in terms of demographic and baseline variables, blood pressure (systolic, diastolic and mean arterial pressure), heart rate, ephedrine intake and incidence of hemodynamic disorders. The frequency of nausea during recovery was significantly different between the three groups (p=0.035); 12 people in the ondansetron 6 mg group, 12 people in the ondansetron 8 mg group and 21 people in the control group had nausea during recovery (40%, 40%, and 70%, respectively). The frequency of vomiting in recovery was significantly different between the three groups (p=0.002); 5 people in the ondansetron 6 mg group, 1 person in the ondansetron 8 mg group, and 12 people in the control group experienced vomiting during recovery (16.7%, 3.3%, and 40%, respectively). Conclusion: The results of this study showed that administration of ondansetron at 6 and 8 mg doses in caesarean section under spinal anesthesia has no significant effect in reducing the incidence of hypotension, bradycardia, and administration of ephedrine and atropine. However, it is associated with a reduction in the incidence of nausea and vomiting in the recovery room (ondansetron 8 mg is more effective than 6 mg).
BMC Anesthesiology, 2018
Background: The weight-based dosing of ondansetron to reduce hypotension has never been investigated. The aim of this study is to determine the optimal dose of ondansetron required based on the patient's weight to reduce hypotension following spinal anesthesia for cesarean section. Methods: In this prospective, triple-blinded, parallel group, randomized controlled trial, a total of 228 pregnant women were randomized to receive either normal saline (group NS) or ondansetron 0.05 mg/kg (group O1) or ondansetron 0. 1 mg/kg (group O2) intravenously 5 min before induction of spinal anesthesia. The incidence of hypotension, mean arterial pressure, heart rate, vasopressor requirements, and blood loss between the three groups were compared. Maternal and neonatal complications were also assessed. Changes in blood pressure and heart rate were compared using the generalized estimating equations method. Results: Thirteen patients were excluded from the analysis because of no intervention (n = 12) and protocol violation (n = 1). Two hundred and fifteen patients remained for the intention-to-treat analysis. The incidence of hypotension in groups NS (n = 72), O1 (n = 71), and O2 (n = 72) were 81.9%, 84.5%, and 73.6%, respectively (P = 0.23). The episodes of hypotension before delivery (first 14 min after spinal anesthesia) were significantly higher in group O1 compared to NS (5 vs 2, P = 0.02). The overall heart rates throughout the operations were not different among the three groups. The ephedrine requirements and amount of blood loss were also similar among the three groups. The metoclopramide requirement was significantly lower in group O2 compared to group NS (2.8% vs 16.7%, P = 0.01). There were no serious adverse events in terms of maternal or neonatal complications.
2020
Background: Spinal anesthesia is the preferred modality of anesthesia for lower segment cesarean section, but it is complicated with hypotension and bradycardia, which may be harmful to both parturient and baby. Bezold–Jarisch reflex plays an important role through 5HT3 receptors located in intracardiac vagal nerve endings in causing hypotension and bradycardia. In this study, we evaluated the effect of ondansetron, as a 5HT3 receptor antagonist, on the hemodynamic response following spinal anesthesia in parturients undergoing elective lower segment cesarean section. Methodology: Sixty parturients who were scheduled for lower segment elective cesarean section were randomly allocated into two groups. Before giving the spinal injection, Group O (n = 30) received intravenous ondansetron 4 mg and Group S (n = 30) received normal saline. Blood pressure, heart rate, and vasopressor requirements were assessed. Results: Total dose of vasopressor (mephentermine) used in Group “O” was 78 mg (...
Hypotension and bradycardia are common adverse effects following spinal anesthesia. Ondansetron has been studied in the attenuation of spinal anesthesia– induced hypotension (SIH) and bradycardia because of its antagonistic effect on the Bezold-Jarisch reflex. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to determine the efficacy of intravenous (IV) ondansetron in reducing the incidence of SIH and bradycardia. Thirteen RCTs were included in this analysis, totaling 1,225 subjects. Hypotension and bradycardia were summarized using a risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was summarized using random-effects model for I 2 greater than 50%; otherwise, a fixed-effects model was performed. Intravenous ondansetron reduced the incidence of hypotension in both the all-procedure analysis group (RR, 0.64; CI, 0.45-0.90) and cesarean delivery group (RR, 0.63; CI, 0.45-0.88). For bradycardia, IV ondansetron resulted in reduced risk (RR, 0.31; CI, 0.19-0.50). Findings of our meta-analysis suggest that IV ondansetron may mitigate the risks of SIH and bradycardia following spinal anesthesia.
Galen Medical Journal, 2016
Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence...
Journal of the Bangladesh Society of Anaesthesiologists
Background: The pathophysiological mechanism involved in the occurrence of hypotension and bradycardia following central neuroaxial blockade is peripheral vasodilatation, parasympathetic dominance and increased baroreceptor activity.Current studies correlate these haemodynamic changes with activation of a phenomenon naming Bezold-Jarisch reflex (BJR). 5-Hydroxytryptamine-3 is an important factor associated with inducing BJR and Ondansetron antagonizes the induction of BJR. Objective: To compare the efficacy between ondansetron and ephedrine as prophylactic against spinal anaesthesia induced hypotension and bradycardia. Method: 120 mothers of ASA grade I and II scheduled for elective caesarean section under spinal anaesthesia were selected and randomized into two equal groups naming Group A(n=60) and Group B (n=60). Group A received Ondansetron IV (0.1mg/kg body wt) and group B Ephedrine (0.15 mg/kg body wt) 5 minutes prior spinal anaesthesia. Data were recorded before and just after...