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Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

Pouran Hajian, Bita Malekianzadeh, Maryam Davoudi

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, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron  given  intravenously  with  antiemetic  dose  (4  mg)  decreases  mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

Anesthesia; Spinal; Cesarean Section; Hemodynamics; Ondansetron

Miller RD. Anesthetic implications of concurrent diseases. In: Miller’s Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingston Elsevier; 2010; 1337–59.

Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local Reg Anesth 2010; 3 (7):143-53.

Owczuk R, wojciechwenski M. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: Reg anesth pain med, 2008, 33(4): 332-9.

Halpern SH, Breen TW, Campbell DC. A multicenter, randomized, controlled trial comparing bupivacaine with ropivacaine for labor analgesia. Anesthesiology. 2003; 98:1431–5.

Siddik SM, Aoud MT, Kai GE. Hydroxyethylstarch 10% is superior to Ringer's solution for preloading before spinal anesthesia for caesarian section. Can J Anesthesia 2000; 47 (5):616-24.

Wisher D. Martindale: The Complete Drug Reference. 37th ed. Journal of the Medical Library Association : JMLA. 2012; 100(1):75-76.

Borgeat A, strnemann HR. ondansetron is effective to treat spinal or epidural morphine induced dpruritis. Anesthesiology 1999; 19 (2): 432-6.

Sudharma J, Birnbach D. Current Status of Obstetric Anesthesia: Improving Satisfaction and Safety. Indian J Anaesth. Oct 2009; 53(5): 608–17.

Somboonviboon W. Incidence and Risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med associ Thai. 2008; 91(2). 181-7.

Brenck B, Hartmann S. Hypotension after spinal anesthesia for cesarean section. J cl in monitcomput. 2009; 23(2): 85-92.

Soltani-Mohammadi S; Aghajani Y; Movafegh A. Comparing Two Different Doses of Intravenous Ondansetron with Placebo on Attenuation of Spinal-induced Hypotension and Shivering. Anesth Pain Med. 4(2): e12055.

White CM, Chow MS, Fan C, Kluger J, Bazunga M. Efficacy of intravenous granisetron in suppressing the bradycardia and hypotension associated with a rabbit model of the Bezold-Jarisch reflex. J Clin Pharmacol. 1998; 38 (2):172–7.

Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszulowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med. 2008; 33(4):332–9.

Kelsaka E, Baris S, Karakaya D, Sarihasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med. 2006; 31(1):40–5.

Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomized, placebo-controlled study. Int J Obstet Anesth. 2012; 21(1):24–8.

Safavi MR, Honarmand A, Negahban M, Attari MA. Prophylactic effects of intrathecal Meperidine and intravenous Ondansetron on shivering in patients undergoing lower extremity orthopedic surgery under spinal anesthesia. J Res Pharm Pract. 2014 Jul-Sep; 3(3): 94–9.

Ortiz-Gómez JR, Palacio-Abizanda FJ, Morillas-Ramirez F, Fornet-Ruiz I, Lorenzo-Jiménez A, Bermejo-Albares ML. The effect of intravenous ondansetron on maternal haemodynamics during elective caesarean delivery under spinal anaesthesia: a double-blind, randomised, placebo-controlled trial. Int J Obstet Anesth. 2014 May; 23(2):138-43.

Wang M, Zhuo L, Wang Q, et al. Efficacy of prophylactic intravenous ondansetron on the prevention of hypotension during cesarean delivery: a dose-dependent study. Int J Clin Exp Med2014;7(12):5210-5216.

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