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Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial.
Reg Anesth Pain Med. 2015 Jul-Aug; 40(4):344-8.RA

Abstract

INTRODUCTION

Hypotension is the most common complication after subarachnoid anesthesia for cesarean delivery. Several therapeutic and preventive measures are used to attenuate this side effect. Serotonin receptor-blocking drugs have been suggested as one such approach. We sought to determine whether prophylactically administered intravenous ondansetron could attenuate hypotension in patients undergoing elective cesarean delivery performed under subarachnoid anesthesia.

METHODS

Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (group O; n = 44) or placebo (group P; n = 42) in a prospective double-blind design. Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), and heart rate (HR) were measured at baseline and at 3-minute intervals from the time of initiation of subarachnoid anesthesia until delivery. Ondansetron effect on hemodynamics (SBP, DBP, MAP, and HR) was quantified and analyzed using a linear mixed effect model.

RESULTS

We did not find differences in SBP (P = 0.78), MAP (P = 0.89), DBP (P = 0.82), or HR (P = 0.18) between the 2 groups during the study period. Phenylephrine requirements to treat hypotension were 350 μg (175-700 μg) in group O and 450 μg (300-700 μg) in group P (P = 0.30). The incidence of pruritus was 63% (n = 28 of 44) in group O and 56% (n = 23 of 42) in group P (difference, 0.08 [95% confidence interval, -0.23 to 0.41], P = 0.59). No difference in the incidence of nausea and vomiting or sensory level was found.

CONCLUSIONS

Ondansetron premedication does not attenuate hemodynamic changes after subarachnoid anesthesia nor does it reduce the amount of vasopressor use, pruritus, or nausea and vomiting.

Authors+Show Affiliations

From the Department of *Anesthesiology, University of Virginia, Charlottesville, VA; and †Department of Epidemiology, Columbia University, New York, NY.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26066384

Citation

Terkawi, Abdullah S., et al. "Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: a Double-Blind, Placebo-Controlled, Randomized Trial." Regional Anesthesia and Pain Medicine, vol. 40, no. 4, 2015, pp. 344-8.
Terkawi AS, Tiouririne M, Mehta SH, et al. Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial. Reg Anesth Pain Med. 2015;40(4):344-8.
Terkawi, A. S., Tiouririne, M., Mehta, S. H., Hackworth, J. M., Tsang, S., & Durieux, M. E. (2015). Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial. Regional Anesthesia and Pain Medicine, 40(4), 344-8. https://doi.org/10.1097/AAP.0000000000000274
Terkawi AS, et al. Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: a Double-Blind, Placebo-Controlled, Randomized Trial. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):344-8. PubMed PMID: 26066384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial. AU - Terkawi,Abdullah S, AU - Tiouririne,Mohamed, AU - Mehta,Sachin H, AU - Hackworth,Jordan M, AU - Tsang,Siny, AU - Durieux,Marcel E, PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2016/4/15/medline SP - 344 EP - 8 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 40 IS - 4 N2 - INTRODUCTION: Hypotension is the most common complication after subarachnoid anesthesia for cesarean delivery. Several therapeutic and preventive measures are used to attenuate this side effect. Serotonin receptor-blocking drugs have been suggested as one such approach. We sought to determine whether prophylactically administered intravenous ondansetron could attenuate hypotension in patients undergoing elective cesarean delivery performed under subarachnoid anesthesia. METHODS: Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (group O; n = 44) or placebo (group P; n = 42) in a prospective double-blind design. Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), and heart rate (HR) were measured at baseline and at 3-minute intervals from the time of initiation of subarachnoid anesthesia until delivery. Ondansetron effect on hemodynamics (SBP, DBP, MAP, and HR) was quantified and analyzed using a linear mixed effect model. RESULTS: We did not find differences in SBP (P = 0.78), MAP (P = 0.89), DBP (P = 0.82), or HR (P = 0.18) between the 2 groups during the study period. Phenylephrine requirements to treat hypotension were 350 μg (175-700 μg) in group O and 450 μg (300-700 μg) in group P (P = 0.30). The incidence of pruritus was 63% (n = 28 of 44) in group O and 56% (n = 23 of 42) in group P (difference, 0.08 [95% confidence interval, -0.23 to 0.41], P = 0.59). No difference in the incidence of nausea and vomiting or sensory level was found. CONCLUSIONS: Ondansetron premedication does not attenuate hemodynamic changes after subarachnoid anesthesia nor does it reduce the amount of vasopressor use, pruritus, or nausea and vomiting. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/26066384/Ondansetron_Does_Not_Attenuate_Hemodynamic_Changes_in_Patients_Undergoing_Elective_Cesarean_Delivery_Using_Subarachnoid_Anesthesia:_A_Double_Blind_Placebo_Controlled_Randomized_Trial_ L2 - http://rapm.bmj.com/cgi/pmidlookup?view=long&pmid=26066384 DB - PRIME DP - Unbound Medicine ER -