Use of Granisetron for prevention of hypotension and bradycardia due to spinal anesthesia: A double blind randomised control trial

Abstract

of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. AbstractBackground: The common adverse effects of spinal anaesthesia include hypotension and bradycardia are due to sympathetic nerve blockade and activation of the Bezold-Jarisch reflex. The Bezold-Jarisch reflex in spinal anaesthesia may be mediated by peripheral 5-HT3 type serotonin receptors. We hypothesized that blockade of type 3 serotonin receptors by using intravenous Granisetron might reduce hypotension and bradycardia induced by spinal anaesthesia. Methodology: Sixty American Society of Anesthesiologists Physical Status I and II patients undergoing lower abdominal surgeries were randomized to receive either Normal Saline (control) or Granisetron 40 mcg/kg intravenously five minutes before subarachnoid block. Heart rates, systolic blood pressure, diastolic blood pressure, mean arterial pressure was recorded every two minutes for ten minutes and then every five minutes for another twenty minutes. Hemodynamic parameters were compared with baseline in each group. Results: There was decrease in all measured variables when compared with baseline values in both groups. There was less reduction in diastolic blood pressure in Granisetron group statistically significant at 10, 15, 20, 25 and 30 minutes. However, the less decrease in mean arterial pressure was statistically significant at 30 minutes only. There were no significant differences in systolic blood pressure and heart rate values between the groups. Conclusions: Granisetron given intravenously does not decrease the incidence of hypotension and bradycardia following subarachnoid block in patients undergoing lower abdominal surgery. However, it attenuates the fall of diastolic and mean arterial pressure spinal anaesthesia.

Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section

“…After SAB, heart rate trend showed non-significant difference between Group G and Group S throughout the study period. Our findings of change in heart rate were similar to Lamichhane et al [ 20 ], Mohammadi et al [ 17 ], and Shrestha et al [ 19 ] in two different studies; although they used higher doses of granisetron in their studies, they failed to observe significant heart rate variations.…”

“…Saberi et al [21] observed that although the granisetron group showed a lesser decrease in systolic blood pressure as compared to normal saline, the difference was not statistically significant. Shrestha et al [19] also observed a similar non-significant difference in systolic blood pressure between the two groups. Both studies did not take surgical blood loss or other influencing factors into account and therefore the findings were different when compared to our study.…”

“…However, Lamichhane et al [ 20 ] who used a similar dosage of granisetron and Shrestha et al [ 19 ] using granisetron at 40mcg/kg did not observe a satisfactory effect of IV granisetron. Both the authors did not take intraoperative blood loss and height of sensory block into account and perhaps the patients of the granisetron group had higher sensory block or more surgical blood loss as compared to the normal saline group.…”

“…Similarly, studies carried out with granisetron by Khalifa [ 15 ], Edalba et al [ 16 ], Mohammadi et al [ 17 ], and Megahed et al [ 18 ] found that it was effective in prevention of hypotension following SAB. However, contrary to the above findings, Shrestha et al [ 19 ], Lamichhane et al [ 20 ], and Saberi et al [ 21 ] found granisetron was not effective in prevention of hypotension following SAB.…”

The Potential of Granisetron in Preventing Spinal Anesthesia Induced Hypotension on Non-Obstetric Procedure

“…The decrease in preload will stimulate the mechanoreceptor and chemoreceptor on the left ventricle wall, which is serotonin sensitive. [5, 10,11] Serotonin released by platelets, enterochromaffin cells, and the nervous system will bind to its receptor, specifically 5-HT3 type then activate the Bezold Jarisch Reflex (BJR). BJR is a cardioinhibitory mechanism with triad hypotension, bradycardia, and apnea.…”