Intravenous ondansetron to prevent hypotension during cesarean section under spinal anaesthesia

Bhiwal, Anil Kumar; Chauhan, Kunal; Choudhary, Sudhanshu; Bhatt, Heena A; Gupta, Sunanda

doi:10.4103/joacc.joacc_61_20

Cited by 3 publications

(9 citation statements)

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“…Notably, 18 additional trials were omitted for the following reasons: conference abstracts (n = 3) [16][17][18] and no available outcomes (n = 15) [6,8,14,[19][20][21][22][23][24][25][26][27][28][29]. Finally, a total of 25 trials that satisfied the eligibility requirements were selected for inclusion in the metaanalysis [2,[11][12][13]. The schematic of the process of literature screening is depicted in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…However, in the aforementioned studies, the sample sizes were relatively small. Furthermore, significant resources have been utilised annually on clinical trials on this topic worldwide [6,7,[11][12][13][14]. Therefore, we conducted this systemic review and meta-analysis using trial sequential analysis (TSA) to investigate whether ondansetron prevents hypotension following spinal anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis

et al. 2022

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Hypotension induced by spinal anaesthesia is a common clinical complication associated with multiple perioperative adverse events. We conducted a systemic review and meta-analysis to confirm whether ondansetron could alleviate hypotension following spinal anaesthesia. PubMed, Embase, Web of Science, and Cochrane Library were searched to identify eligible randomised controlled trials from their respective database inception dates to 30 September 2022. The primary outcome of the meta-analysis was the incidence of hypotension after spinal anaesthesia. The risk of bias in the included studies was evaluated using the revised Cochrane risk of bias tool for randomised trials (RoB 2.0). Grading of Recommendations, Assessment, Development, and Evaluation was applied to assess the level of certainty. A total of 25 studies were included in this research. The meta-analysis revealed that ondansetron significantly decreased the incidence of hypotension (RR = 0.65, 95% CI 0.53–0.80, p < 0.01, I2 = 64%) and bradycardia. In addition, patients treated with ondansetron had a reduced need for vasopressors administration. This study suggests that ondansetron may be recommended as a prophylaxis for hypotension and bradycardia following spinal anaesthesia; the level of evidence was moderate with a high level of heterogeneity.

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Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis

et al. 2022

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“…It also suppresses further expansion of peripheral vessels and increases venous return to the heart [23]. Although 4 mg of ondansetron preloading has been commonly used to reduce maternal hypotension and nausea, the dose-dependent effect of ondansetron on reducing maternal hypotension is still not established clearly and needs further studies [9][10][11]14,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Bhiwal et al [ 22 ] also did a study comparing two doses of ondansetron (4 mg and 8 mg) in 150 parturients and used normal saline as control. They found that prophylactic use of ondansetron was helpful in the prevention of maternal hypotension and decreases the use of vasopressor with 8 mg ondansetron having a better reduction in vasopressor requirement.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies conducted on both non-obstetric [6,7] and obstetric [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] populations suggest that 5-HT may be an important factor associated with cardiovascular responses via the BJR and this effect can be blocked at the 5-HT3 receptor by 5-HT3 receptor antagonists like ondansetron.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial

Vashishth¹,

Lal²,

Bangarwa³

et al. 2022

Cureus

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IntroductionSpinal anaesthesia is frequently associated with adverse effects like maternal hypotension and bradycardia. This effect is due to a decrease in systemic vascular resistance, a decrease in central venous pressure or Bezold-Jarisch Reflex (mediated by 5-HT3 receptors). We aimed to measure the effect of three different doses of prophylactic intravenous ondansetron (5-HT3 antagonists) with a placebo on maternal haemodynamics. MethodsA prospective randomised control study was done over 240 parturients, aged 19-35 years. They were randomly allocated into four groups (n=60) Group O4, Group O6, Group O8 and Group S to receive either intravenous ondansetron 4 mg, 6 mg, 8 mg or 0.9% normal saline respectively. Haemodynamic variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate [HR]) were recorded at 2-minute intervals for the first 20 minutes and at 5-minute intervals for further 30 minutes. ResultsA significant decrease in haemodynamic parameters was observed in group S when compared with ondansetron groups at various time intervals (p<0.05). The difference was most significant in groups O6 and O8. Development of nausea and vomiting was significantly higher in Group S compared to ondansetron groups (p< 0.005). The requirement for ephedrine was more in Group S in comparison to ondansetron groups (p<0.0001). ConclusionAll three groups of ondansetron showed a decrease in the incidence of hypotension and use of vasopressor but Group O6 and O8 were more effective in attenuating spinal-induced hypotension in parturients undergoing caesarean section.

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Effect of Intravenous Ondansetron on Spinal Anaesthesia-Induced Hypotension During Caesarean Section

Nazir,

Muhammad Abdul Rehman,

Zahid

et al. 2024

JHRR

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Background: Spinal anaesthesia has become the preferred method for elective caesarean sections due to its simplicity, speed, and reliability. However, a significant challenge with this technique is maternal hypotension, which can lead to nausea, vomiting, and decreased cardiac output, necessitating effective preventive measures. Ondansetron, a 5-HT3 receptor antagonist, is commonly used to prevent nausea and vomiting, and recent studies suggest its potential efficacy in reducing hypotension during spinal anaesthesia. Objective: To compare the frequency of hypotension during spinal anaesthesia for elective caesarean delivery between two groups: one receiving intravenous ondansetron and the other receiving normal saline as a placebo. Methods: This randomized controlled trial was conducted at the Department of Anaesthesia, Combined Military Hospital Sialkot, over six months (May 6, 2016, to November 6, 2016). A total of 60 pregnant women scheduled for elective caesarean delivery under spinal anaesthesia, aged 18-35 years, classified as ASA I or II, and carrying a singleton pregnancy at 37-42 weeks, were included. Exclusion criteria included contraindications to spinal anaesthesia, history of heart or lung disease, known hypersensitivity to the study medication, diabetes with blood sugar >180 mg/dl, hypertension with blood pressure >160/90 mmHg, morbid obesity, and fetal abnormalities. Participants were randomly assigned to Group A (intervention) receiving 4 mg ondansetron intravenously in 10 ml saline 5 minutes before spinal anaesthesia, or Group B (control) receiving 10 ml saline intravenously. Baseline vitals, including heart rate, mean arterial pressure, systolic and diastolic blood pressure, were recorded. Spinal anaesthesia was administered using a 25-gauge needle with 2.5 ml of hyperbaric 0.5% bupivacaine solution. Hypotension was managed with intravenous bolus of 100 mcg phenylephrine and 100 ml normal saline. Data were analyzed using SPSS version 25.0, with qualitative variables compared using chi-square tests and significance set at p ≤ 0.05. Results: The mean age of participants was 27.95±5.68 years, and the mean BMI was 24.12±3.30 kg/m². Baseline systolic blood pressure averaged 129.00±11.24 mmHg, diastolic blood pressure 71.67±6.99 mmHg, and mean arterial pressure 114.67±7.93 mmHg. In Group A, 8 out of 30 participants (26.7%) experienced hypotension compared to 17 out of 30 participants (56.7%) in Group B (p=0.036). Stratification by age revealed a significant difference in hypotension incidence in participants >26 years (p=0.028). No significant differences were observed when stratified by BMI <24 kg/m² (p=0.056) and >24 kg/m² (p=0.300). Conclusion: Administration of 4 mg intravenous ondansetron 5 minutes prior to spinal anaesthesia for elective caesarean delivery significantly reduces the frequency of hypotension compared to placebo, especially in patients older than 26 years. Ondansetron appears to be a practical and cost-effective prophylactic measure against spinal anaesthesia-induced hypotension, warranting further large-scale, multi-centre trials to validate these findings.

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Intravenous ondansetron to prevent hypotension during cesarean section under spinal anaesthesia

Cited by 3 publications

References 10 publications

Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis

Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis

Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial

Effect of Intravenous Ondansetron on Spinal Anaesthesia-Induced Hypotension During Caesarean Section

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