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

Hou, Xiaomin; Chen, Yan-Jun; Lai, Lan; Liu, Ke; Shen, Qi-Hong

doi:10.3390/ph15121588

Cited by 4 publications

(2 citation statements)

References 49 publications

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“…The frequency of hypotension in the intervention group was substantially lower than in the control group, indicating that ondansetron effectively mitigates the risk of this common and potentially dangerous side effect. This aligns with previous research, such as the studies by Sahoo et al and El Khouly et al, which demonstrated similar reductions in hypotension with prophylactic ondansetron administration (11,12,14). The study's results are particularly noteworthy in the subgroup analysis, where the difference in hypotension incidence was significant in patients over 26 years of age.…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

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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“…Prior to surgical incision, an additional pinprick evaluation at the T4 level was used to assess the adequate level of NA in all patients. All the patients received ondansetron 0.1mg/Kg IV to reduce postoperative nausea and vomiting (PONV) and reduce the incidence of hypotension after spinal anaesthesia [12]. In all patients, sedation was performed during surgery with small bolus injections of intravenous midazolam, up to 5mg, and ketamine 0.15-0.3mg/kg/h.…”

Section: Neuraxial Anaesthesia: Technical Proceduresmentioning

confidence: 99%

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Leoni,

Rossi,

Mercieri

et al. 2024

Preprint

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Introduction Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using lumbar spinal anaesthesia as the primary anaesthetic technique in emergency laparotomies. Methods We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Lumbar spinal anaesthesia was employed as the main anaes-thetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoper-ative pain control, the incidence of postoperative complications, and mortality rates. Results Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in 7 patients (44%). The observed mortality rate was relatively low at 6% (1 patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Discussion Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that lumbar spinal anaesthesia may be a useful alternative in emer-gency settings. However, the occurrence of postoperative complications in 44% of patients indi-cates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this tech-nique on patient outcomes in emergency laparotomies.

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Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial

Sheng,

Sun,

Mao

et al. 2023

International Journal of Surgery

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Background: Ondansetron has been reported to attenuate the incidence of spinal anesthesia-induced hypotension (SAIH) and norepinephrine requirement during cesarean section. However, no quantitative study has evaluated the extent of this effect. This study aimed to determine the dose-response of prophylactic infusion of norepinephrine to prevent SAIH in parturients who received intravenous ondansetron or placebo before spinal anesthesia for cesarean section. The median effective dose (ED50) and 90% effective dose (ED90) were compared to evaluate the effect of ondansetron versus placebo on the norepinephrine requirement. Materials and methods: 150 parturients undergoing cesarean section were randomized to receive either 0.1 mg/kg ondansetron or saline control 10 min before spinal anesthesia. The parturients were randomly assigned to one of five different norepinephrine infusion groups: 0.02, 0.04, 0.06, 0.08 or 0.10 µg/kg/min. An effective infusion dose of norepinephrine was defined as non-occurrence of hypotension during the study period. The values for ED50 and ED90 of norepinephrine infusion were determined using probit regression. Differences between the two groups were evaluated by comparing the relative median potency with 95% confidence intervals (CIs). Results: The ED50 values were 0.033 (95% CIs, 0.024-0.043) µg/kg/min in group C and 0.021 (95% CIs, 0.013-0.029) µg/kg/min in group O. The ED90 values were 0.091 (95% CIs 0.068-0.147) µg/kg/min in group C and 0.059 (95% CIs 0.044-0.089) µg/kg/min in group O, respectively. The estimate of the relative median potency for norepinephrine in group C versus group O was 0.643 (95% CIs, 0.363-0.956). The incidence of side effects was comparable between groups. No significant difference in neonatal outcomes. Conclusion: Intravenous ondansetron 0.1 mg/kg before spinal anesthesia significantly reduced the dose requirement of prophylactic norepinephrine infusion in parturients undergoing elective cesarean section. This finding is potentially useful for clinical practice and further research.

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

Cited by 4 publications

References 49 publications

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

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

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial

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