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

Trabelsi, W.; Romdhani, Chihebeddine; Elaskri, Haythem; Sammoud, W.; Bensalah, Mohamed; Labbène, Iheb; Ferjani, Mustapha

doi:10.1155/2015/158061

Cited by 39 publications

(58 citation statements)

References 18 publications

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“…A meta‐analysis by Heesen et al . found less of a decrease in blood pressure among patients treated with 5‐HT 3 antagonists in all included obstetric studies . These findings were confirmed by the current results but seem to be caused by increased administration of sympathomimetics.…”

Section: Discussionsupporting

confidence: 87%

“…found no difference among patients needing treatment with sympathomimetics during CD . When investigating the total dose of vasopressors, several studies found decreased requirements for ephedrine or phenylephrine among patients previously treated with 5‐HT 3 antagonists; however, the present study recorded a substantially higher need for sympathomimetics among the granisetron group versus the control group.…”

Section: Discussioncontrasting

confidence: 78%

“…fluid bolus or vasoconstrictors). These drugs are increasingly used in a multimodal prophylactic approach to prevent maternal hypotension and to ensure intraprocedural hemodynamic stability during CD performed under SPA by blocking the Bezold–Jarisch reflex . A meta‐analysis of eight obstetric studies and nine non‐obstetric studies found a positive effect of the 5‐HT 3 receptor antagonist ondansetron on hemodynamic stability among the obstetric studies .…”

Section: Introductionmentioning

confidence: 99%

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Granisetron reduces the need for uterotonics but not sympathomimetics during cesarean delivery

Raimann

Baldauf

Louwen

et al. 2019

Intl J Gynecology & Obste

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Objective To assess the effect of a 5‐hydroxytryptamine‐3 receptor antagonist (granisetron) on the use of sympathomimetic (cafedrine/theodrenaline) and uterotonic (oxytocin) agents after spinal anesthesia during cesarean delivery. Methods A retrospective observational analysis was conducted using intraoperative records (n=240) created at a single hospital in Germany between November 1, 2016, and July 31, 2017. The granisetron group (n=120) had received 3 mg of granisetron immediately before induction of spinal anesthesia. The control group (n=120) had not received granisetron. The primary endpoints were the intraoperative requirements for sympathomimetic and uterotonic agents. The secondary endpoints were parameters of intraprocedural maternal hemodynamic and clinical states. Results More patients in the granisetron group than in the control group received intraoperative cafedrine/theodrenaline (P=0.045), with the cumulative intraoperative dosage also increased in the granisetron group (P=0.016). By contrast, the cumulative intraoperative dose of oxytocin was lower in the granisetron group than in the control group (P<0.001). Decreases in heart rate and mean arterial blood pressure were lower in the granisetron group versus the control group (P=0.015 and P=0.002, respectively). Conclusion Treatment with granisetron immediately before cesarean delivery did not reduce the perioperative requirement for sympathomimetics but did reduce the need for uterotonics. Registered at ClinicalTrials.gov (NCT03318536)

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Granisetron reduces the need for uterotonics but not sympathomimetics during cesarean delivery

Raimann

Baldauf

Louwen

et al. 2019

Intl J Gynecology & Obste

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“…[19] However, it should be noted that different hypotension's management protocols were used. They found that prophylactic ondansetron (4 mg) had a significant effect on the incidence of hypotension in healthy parturient undergoing SA for elective cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

“…also reported that ondansetron can be helpful to improve metabolic and vital parameters of newborns. [19]…”

Section: Discussionmentioning

confidence: 99%

Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial

et al. 2017

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Background:Prophylactic administrations of ondansetron or phenylephrine have been reported to provide a protective effect against hypotension in women undergoing cesarean delivery under spinal anesthesia (SA). The main hypothesis is that ondansetron improves the hemodynamic response, especially combined with phenylephrine infusion.Methods:This prospective, double-blind, randomized, placebo-controlled study included 265 healthy pregnant women scheduled for elective cesarean delivery under SA. Women were randomly allocated into four groups to receive either placebo (control), ondansetron (O) 8 mg intravenously before induction of SA, phenylephrine infusion (50 mcg/min) (P) or ondansetron plus phenylephrine (OP). Demographic, obstetric, intraoperative timing, and anesthetic variables were assessed at 16 time points. Anesthetic variables assessed included blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus, and vasopressor requirements.Results:There were differences (P = 0.0001) in the number of patients with hypotension (50.8% control, 44.6% O, 20.9% P, 25.0% OP), the percentage of time points (P = 0.0001) with systolic hypotension per patient (17.4% control, 8.7% O, 2.1% P, 6.7% OP) and the number of patients requiring supplementary boluses of ephedrine (P = 0.003), phenylephrine (P = 0.017) or atropine (P = 0.0001).Conclusions:A 50 μg/min phenylephrine infusion reduces by 50%, the incidence of maternal hypotension compared with placebo, but infusions of phenylephrine are still not routine in our environment. Prophylactic ondansetron 8 mg might be considered in this situation, because it does not reduce the incidence of maternal hypotension but diminishes its severity, reducing the number of hypotensive events per patient by 50%.

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Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Chooi

Cox

Lumb

et al. 2017

Cochrane Database of Systematic Reviews

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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

Abstract: To prevent hypotension during spinal anesthesia for caesarean section, we assessed IV ondansetron of invasive maternal hemodynamic and fetal gazometric parameters.

Cited by 39 publications

References 18 publications

Granisetron reduces the need for uterotonics but not sympathomimetics during cesarean delivery

Granisetron reduces the need for uterotonics but not sympathomimetics during cesarean delivery

Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

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