Evaluation of the effects of prespinal administration of Ondansetron on maternal hemodynamics

  • Dr. Arivumani T A Assistant Professor, Department of Anaesthesia, Tagore Medical College and Hospital, Rathinamangalam, Chennai, India
  • Dr. Arul Anne Rose S Associate Professor, Department of Obstetrics and Gynaecology, Tagore Medical College and Hospital, Rathinamangalam, Chennai, India
  • Dr.Ushadevi G Professor, Department of Obstetrics and Gynaecology, Tagore Medical College and Hospital, Rathinamangalam, Chennai, India
Keywords: Ondansetron, Spinal anaesthesia, LSCS, Hypotension, Bradycardia

Abstract

Introduction: Spinal anaesthesia is the preferred method of anaesthesia for elective lower segment caesarean section (LSCS). It has a shorter onset time, but is associated with hypotension and bradycardia,which at times may be deleterious to both mother and fetus.

Aim of Study: To evaluate the effects of intravenous administration of ondansetron prior to spinal anaesthesia on the hemodynamic responses in the mother specifically hypotension and bradycardia.

Materials and Methods: The study was a hospital based prospective, double-blinded, randomized, placebo controlled study in our teaching medical college and hospital over a period of 6 months –February to July 2015.As per inclusion and exclusion criteria of our study, study population ( 72 patients) was identified who were planned for elective LSCS. They were randomly allocated into two groups. 5 minutes prior to spinal anaesthesia, group O (n =36) received 4mg IV Ondansetron and group P (n = 36) received physiological saline. Blood pressure and heart rate were monitored once in 5 minutes for 30 minutes, and requirement of vasopressors was noted.

Results: Hypotension was significantly lower in group O when compared to group P. Bradycardia was less in number in group O but it was statistically insignificant. Vasopressor requirement was also lower in group O patients.

Conclusion: Intravenous Ondansetron 4mg given 5 minutes prior to spinal anaesthesia significantly reduces the hypotension. The episodes of bradycardia as well as the requirement of vasopressors in parturients were low in ondansetron group, which was found to be statistically insignificant, may be due to less number of study population.

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References

1. Kar W Ng, Jacqueline Parsons, Allan M Cyna, Philippa Middleton. Spinal versus epidural anaesthesia for caesarean section. .pub2/ abstract. retrieved on 23.6.11

2. Stewart A, Fernando R, Mc Donald S, Hignett R, Jones T, Columb M. The dose – dependent effects of phenylephrine for elective cesarean delivery under spinal anaesthesia. Anesth Analg. 2010 Nov; 111(5): 1230- 37. doi: 10.1213/ANE.0b013e3181f2eae1. Epub 2010 Sep 14.

3. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005 Jul;60(7):636-53.

4. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006 Oct 18;(4): CD 002251

5. Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology. 2003 May;98(5):1250-60.

6. Aviado DM, Guevara Aviado D. The Bezold-Jarisch reflex. A historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci. 2001 Jun;940:48-58.

7. Christofaki M, Papaioannou A. Ondansetron: a review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opin Drug Metab Toxicol. 2014 Mar;10(3):437-44. doi: 10.1517/17425255.2014.882317. Epub 2014 Jan 28.

8. Yeh YC, McDonnell A, Klinger E, Fowler B, Matta L, Voit D, Reddy P. Comparison of healthcare resource use between patients receiving ondansetron or palonosetron as prophylaxis for chemotherapy-induced nausea and vomiting. J Oncol Pharm Pract. 2011 Sep;17(3):179-85. doi: 10.1177/1078155210366491. Epub 2010 May 7.

9. Tucker ML, Jackson MR, Scales MD, Spurling NW, Tweats DJ, Capel-Edwards K. Ondansetron: pre-clinical safety evaluation. Eur J Cancer Clin Oncol. 1989;25 Suppl 1:S79-93.

10. Adrienne Einarson, Caroline Maltepe, Yvette Navioz, Deborah Kennedy, Michael Paul Tan, Gideon Koren. The saftey of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG.2004 Sep; vol 111 pp. 940-43. DOI: 10.1111/j.1471-0528.2004.00236.x

11. Martinek RM.Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Can J Anaesth. 2004 Mar;51(3):226-30.

12. Gyermek L. Pharmacology of serotonin as related to anesthesia. J Clin Anesth. 1996 Aug;8(5):402-25.

13. Mao HZ, Li Z, Chapleau MW. Platelet activation in carotid sinuses triggers reflex sympathoinhibition and hypotension. Hypertension. 1996 Mar;27(3 Pt 2):584-90.

14. Kinsella SM, Lohmann G. Supine hypotensive syndrome. Obstet Gynecol. 1994 May;83(5 Pt 1):774-88.

15. S.W.Y.Lee, K.S.Khaw, W.D.Ngan Kee, T.Y.Leung and L.A.H.Critchley. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. British Journal of Anaesthesia 2012; 109(6): 950-6 doi: 10. 1093/ bja/ aes/ 349

16. Mark AL. The Bezold- Jarisch reflex revisited clinical implication of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983; 1(1): 90-102

17. Yamano M, Kamato T, Nishida A, Ito H, Yuki H, Tsutsumi R, Honda K, Miyata K. Serotonin (5-HT)3-receptor antagonism of 4,5,6,7-tetrahydrobenzimidazole derivatives against 5-HT-induced bradycardia in anesthetized rats. Jpn J Pharmacol. 1994 Jul;65(3):241-8.

18. Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth. 2001 Jun;86(6):859-68.

19. Fassoulaki A, Melemeni A, Zotou M, Sarantopoulos C. Systemic ondansetron antagonizes the sensory block produced by intrathecal lidocaine. Anesth Analg. 2005 Jun;100(6):1817-21.

20. Hessami MA, Yari M. Granisetron versus dexamethasone in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy. Anesth Pain Med. 2012 Fall;2(2):81-4. doi: 10.5812/aapm.6945. Epub 2012 Sep 13.

21. Jabbary Moghaddam M, Ommi D, Mirkheshti A, Dabbagh A, Memary E, Sadeghi A, et al. Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries. Anesth Pain Med.2013; 2(3):107-10. doi:10.5812/aapm.7143.

22. Golfam P, Yari M, Bakhtiyari HR. Minimum appropriate dose of lidocaine with a fixed dose of sufentanil epinephrine used for spinal anesthesia in caesarian section. Anesth Pain Med. 2013 Winter;2(3):123-6. doi: 10.5812/aapm.7810. Epub 2013 Jan 1.

23. Fathi M, Imani F, Joudi M, Goodarzi V. Comparison Between the Effects of Ringer’s Lactate and Hydroxyethyl Starch on Hemodynamic Parameters After Spinal Anesthesia: A Randomized Clinical Trial. Anesth Pain Med.2013 Winter; 2(3):127-33. doi: 10.5812/aapm.7850

24. Marashi SM, Soltani-Omid S, 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. 2014 Mar 18;4(2):e12055. doi: 10.5812/aapm.12055. eCollection 2014.

25. 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 Jul-Aug;33(4):332-9. doi: 10.1016/j.rapm.2008.01.010.

26. Meng Wang , LangZhuo, Qun Wang, Ming-Kun Shen, Yan- Yun Yu, Jun- Jing Yu, Zhi, Ping Wang. Efficacy of prophylactic intravenous ondansetron on the prevention of hypotension during cesarean delivery: a dose- dependent study. Int J Clin Exp Med 2014; 7(12):5210-16

27. Sahoo T, Sen Dasgupta C, Goswami A, Hazra A. Reduction in spinal –induced in Hypotension with ondansetron in parturients undergoing caesarean section: a double- blind randomised, placebo-controlled study. Int J Obstet Anesth. 2012 Jan;21(1):24-8. doi: 10.1016/j.ijoa.2011.08.002. Epub 2011 Nov 18.
CITATION
DOI: 10.17511/ijmrr.2016.i05.04
Published: 2016-05-31
How to Cite
1.
T A A, Rose S AA, G U. Evaluation of the effects of prespinal administration of Ondansetron on maternal hemodynamics. Int J Med Res Rev [Internet]. 2016May31 [cited 2024Apr.20];4(5):689-94. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/541
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