Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial

Aksoy, Mehmet; Dostbil, Ayşenur; Aksoy, Ayşe; İnce, İlker; Bedir, Zehra; Özmen, Özgür

doi:10.1016/j.jclinane.2021.110469

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…17 More recently in a study conducted by Aksoy et al, it was documented that high doses of ondansetron (8 mg) or granisetron (3 mg) prevented hypotension in cesarean section under spinal anesthesia achieved with 9 mg of isobaric bupivacaine. 18 Similar results were observed in a trial of a non-obstetric population, conducted by Mendonca et al, when 8 mg of ondansetron were given in patients undergoing spinal anesthesia achieved with 15 mg bupivacaine or more, along with adjuvant opioids. 19 In the study of Fei et al, a significant reduction in the ED50 of phenylephrine infusion was noted in parturients undergoing spinal anesthesia, achieved with 10 mg hyperbaric bupivacaine and sufentanil, when 4 mg of ondansetron were given ten minutes before spinal anesthesia.…”

Section: Discussionsupporting

confidence: 75%

Failure of two different doses of ondansetron to prevent maternal hypotension in spinal anesthesia with ropivacaine 0.75% for cesarean section; a randomized, double blind trial.

Karachanidi¹

2023

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Introduction: Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, commonly used as an antiemetic has been proven in recent studies to be effective for the prevention of spinalinduced hypotension for elective cesarean section. Methods:One hundred and thirty-eight healthy primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Participants in the ONDA4, ONDA8, and CONTROL groups received 4 mg of ondansetron, 8 mg of ondansetron and normal saline respectively, 10 minutes before spinal anesthesia. Spinal anesthesia was performed at L3-L4 interspinous space, with 1.7 ml ropivacaine 0.75% and 15 mcg of fentanyl, via a 27 G pencil point needle. Blood pressure and heart rate were recorded upon arrival at the operating room, after preloading with 500 ml of 6% hydroxyethylstarch, at the time of spinal injection, and at oneminute intervals for 10 minutes thereafter. Blood pressure and heart rate values, total phenylephrine (mcg) or/and ephedrine (mg) doses, the incidence of maternal nausea/vomiting/shivering, umbilical artery pH and Apgar scores at 1 and 5 min were recorded. Time for the sensory block to reach T4 and regress to T7 dermatome, and the time for the motor block to reach Bromage scale 3 and to regress to Bromage scale 1, were also noted.Results: There were no differences between groups in hemodynamic parameters or doses of vasoactive agents used, sensory or motor block characteristics, incidence of nausea/vomiting, umbilical artery pH or Apgar scores of the neonates. Conclusion:Our results failed to demonstrate the significance of ondansetron in preventing maternal hypotension following spinal anesthesia for cesarian section.

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Section: Discussionsupporting

confidence: 75%

Failure of two different doses of ondansetron to prevent maternal hypotension in spinal anesthesia with ropivacaine 0.75% for cesarean section; a randomized, double blind trial.

Karachanidi¹

2023

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“…Numerous previous studies investigated the effect of 5-HT 3 receptor antagonists on hypotension induced by spinal anesthesia 29 – 31 . Interestingly, the results of these studies were inconsistent.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous granisetron on prophylactic ephedrine for preventing hypotension after general anaesthesia induction in elderly patients: a randomized controlled trial

Victor

Lin

et al. 2023

Sci Rep

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Serotonin 3 receptor antagonists, a commonly used drug for preventing postoperative nausea and vomiting, have recently been reported to decrease the incidence of hypotension and the need for vasoactive drugs after spinal anaesthesia in obstetric surgery. However, it remains unknown whether they could also prevent hypotension after induction of general anaesthesia. In the current study, we aimed to investigate the effect of intravenous granisetron on prophylactic ephedrine for preventing hypotension after general anaesthesia induction in elderly patients. Sixty elderly patients were randomly assigned to receive granisetron or saline control 30 min before induction of general anaesthesia. The first patient in each group received a prophylactic dose of ephedrine (0.15 mg kg−1) to prevent hypotension. The prophylactic dose for each patient was increased or decreased by 0.05 mg/kg based on the efficacy results of the previous patient. The up-down sequential allocation analysis and probit regression was used to calculate the effective dose for 50% of patients (ED50) with prophylactic ephedrine. In the up-down sequential allocation analysis, the ED50 of ephedrine was significantly lower in group granisetron (0.08 mg kg−1 [95% CI, 0.06–0.11 mg kg−1]) when compared with group control (0.14 mg kg−1 [95% CI, 0.13–0.16 mg kg−1]) (P < 0.001). The conclusion was further supported by probit regression analysis (0.09 mg kg−1 [95% CI, 0.05–0.12 mg kg−1] in group granisetron and 0.14 mg kg−1 [95% CI, 0.12–0.16 mg kg−1] in group control). Intravenous granisetron reduced the requirement of prophylactic ephedrine in preventing hypotension after general anaesthesia induction in elderly patients.

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“…Hence, the important finding of the present study is the increased efficacy of granisetron in prevention of hemodynamic responses associated with spinal block. Aksoy granisetron are equally effective 1 . A similar study by Khalifa in 2015 with 80 parturients comparing 1 mg granisetron with 4 mg ondansetron concluded that while both drugs are effective in prevention of hemodynamic fluctuations, ondansetron is superior.…”

Section: Discussionmentioning

confidence: 99%

“…Use of 5HT 3 receptor antagonists is among the novel therapeutic approaches being employed to battle with the notorious hemodynamic complications associated with spinal anaesthesia: hypotension and bradycardia. 1 The antiemetic drugs, ondansetron and granisetron, are two such commonly used 5HT 3 receptor antagonists.…”

Section: Introductionmentioning

confidence: 99%

Granisetron versus Ondansetron: Comparison of 5HT3 antagonists in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients

Wahid

Ali²,

Yasin³

et al. 2022

Pak J Med Sci

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Objectives: To evaluate and compare the Ondansetron and Granisetron in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients Methods: The comparative analytical study was conducted at Combined Military Hospital, Rawalpindi, from September to October, 2021. One hundred and twenty pregnant women undergoing cesarean section, were enrolled in the study via non probability convenience sampling, and divided into three groups containing 40 participants each based on the type of antiemetic premedication they received, if any: Group N were those not requiring antiemetic premedication, Group O consisted of those given ondansetron 4mg, and Group G had those receiving 3mg granisetron, 15 minutes prior to administration of spinal anaesthesia. Systolic blood pressures and heart rates were recorded before and at multiple intervals after spinal anaesthesia was administered. Episodes of hypotension and bradycardia were recorded. Requirement of phenylephrine and atropine as rescue drugs was recorded for each participant. Results: There was a statistically significant difference in incidence of hypotension among the three groups (p value <0.001), with both drugs being superior to the control group (p value <0.001 for both), and 3mg granisetron being superior to 4mg ondansetron (p value <0.001). As for incidence of bradycardia, ondansetron and granisetron were superior to control group (p value 0.03 and <0.001 respectively), but there was no significant difference between the two drug groups (p value 0.094). Conclusion: High dose granisetron (3mg) is superior to low dose ondansetron (4mg) in preventing hemodynamic fluctuations induced by spinal anaesthesia. doi: https://doi.org/10.12669/pjms.38.7.5585 How to cite this:Wahid M, Ali S, Yasin B, Farhat K, Noor M, Syed FT. Granisetron versus Ondansetron: Comparison of 5HT3 antagonists in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.5585 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial

Cited by 14 publications

References 24 publications

Failure of two different doses of ondansetron to prevent maternal hypotension in spinal anesthesia with ropivacaine 0.75% for cesarean section; a randomized, double blind trial.

Failure of two different doses of ondansetron to prevent maternal hypotension in spinal anesthesia with ropivacaine 0.75% for cesarean section; a randomized, double blind trial.

The effect of intravenous granisetron on prophylactic ephedrine for preventing hypotension after general anaesthesia induction in elderly patients: a randomized controlled trial

Granisetron versus Ondansetron: Comparison of 5HT3 antagonists in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients

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