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Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study.

Abstract

Background

Spinal anesthesia is a safe anesthetic technique commonly practiced. However, it is associated with hypotension (33%), bradycardia (13%), and shivering which are induced by hypovolemia, sympathetic blockade, and Bezold-Jarisch reflex through intracardiac serotonin (5HT3) receptors and vagus nerve.

Aim

To study the effect of intravenous (i.v.) ondansetron on hypotension and bradycardia induced by spinal anesthesia.

Setting and Design

This was a randomized controlled double-blinded study done in a tertiary care teaching hospital.

Methods

Of 140 patients, 70 in Group A received 2 mL of i.v. ondansetron 4 mg and 70 in the Group B received 2 mL of i.v. normal saline. 3 mL of 0.5% hyperbaric bupivacaine was injected intrathecally. Measurements of blood pressure and heart rate (HR) were taken every 3 min for 30 min after spinal anesthesia was performed. Mean arterial pressure (MAP) drop more than 20% was considered as incidence of hypotension and ephedrine 6 mg i.v. was given. HR drop >20% was regarded as bradycardia and atropine 0.5 mg i.v. was given.

Statistical Tests

Quantitative data were analyzed using ANOVA test and qualitative data were analyzed using Chi-square test.

Results

Both groups are comparable in demographic data. Four (5.7%) patients in Group B and no patients in Group A had incidence of bradycardia and atropine requirement (P = 0.120). There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, and MAP. 19 (27%) patients in Group A and 33 (47.1%) in Group B required ephedrine with P = 0.029. 12 (17.1%) in Group B and no patients in Group A had shivering with P = 0.0001.

Conclusion

Our study indicates that prophylactic use of ondansetron before spinal anesthesia significantly reduces the requirement of ephedrine and shivering.

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  • Authors+Show Affiliations

    ,

    Department of Anaesthesiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India.

    ,

    Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India.

    ,

    Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India.

    ,

    Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India.

    ,

    Department of Anaesthesiology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India.

    Department of Anaesthesiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31198257

    Citation

    Tatikonda, Chandra Mouli, et al. "Effect of Intravenous Ondansetron On Spinal Anesthesia-Induced Hypotension and Bradycardia: a Randomized Controlled Double-Blinded Study." Anesthesia, Essays and Researches, vol. 13, no. 2, 2019, pp. 340-346.
    Tatikonda CM, Rajappa GC, Rath P, et al. Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. Anesth Essays Res. 2019;13(2):340-346.
    Tatikonda, C. M., Rajappa, G. C., Rath, P., Abbas, M., Madhapura, V. S., & Gopal, N. V. (2019). Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. Anesthesia, Essays and Researches, 13(2), pp. 340-346. doi:10.4103/aer.AER_22_19.
    Tatikonda CM, et al. Effect of Intravenous Ondansetron On Spinal Anesthesia-Induced Hypotension and Bradycardia: a Randomized Controlled Double-Blinded Study. Anesth Essays Res. 2019;13(2):340-346. PubMed PMID: 31198257.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. AU - Tatikonda,Chandra Mouli, AU - Rajappa,Geetha C, AU - Rath,Prapti, AU - Abbas,Mohammad, AU - Madhapura,Vishnu S, AU - Gopal,Nori Venu, PY - 2019/6/15/entrez PY - 2019/6/15/pubmed PY - 2019/6/15/medline KW - Bezold–Jarisch reflex KW - ondansetron KW - spinal anesthesia SP - 340 EP - 346 JF - Anesthesia, essays and researches JO - Anesth Essays Res VL - 13 IS - 2 N2 - Background: Spinal anesthesia is a safe anesthetic technique commonly practiced. However, it is associated with hypotension (33%), bradycardia (13%), and shivering which are induced by hypovolemia, sympathetic blockade, and Bezold-Jarisch reflex through intracardiac serotonin (5HT3) receptors and vagus nerve. Aim: To study the effect of intravenous (i.v.) ondansetron on hypotension and bradycardia induced by spinal anesthesia. Setting and Design: This was a randomized controlled double-blinded study done in a tertiary care teaching hospital. Methods: Of 140 patients, 70 in Group A received 2 mL of i.v. ondansetron 4 mg and 70 in the Group B received 2 mL of i.v. normal saline. 3 mL of 0.5% hyperbaric bupivacaine was injected intrathecally. Measurements of blood pressure and heart rate (HR) were taken every 3 min for 30 min after spinal anesthesia was performed. Mean arterial pressure (MAP) drop more than 20% was considered as incidence of hypotension and ephedrine 6 mg i.v. was given. HR drop >20% was regarded as bradycardia and atropine 0.5 mg i.v. was given. Statistical Tests: Quantitative data were analyzed using ANOVA test and qualitative data were analyzed using Chi-square test. Results: Both groups are comparable in demographic data. Four (5.7%) patients in Group B and no patients in Group A had incidence of bradycardia and atropine requirement (P = 0.120). There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, and MAP. 19 (27%) patients in Group A and 33 (47.1%) in Group B required ephedrine with P = 0.029. 12 (17.1%) in Group B and no patients in Group A had shivering with P = 0.0001. Conclusion: Our study indicates that prophylactic use of ondansetron before spinal anesthesia significantly reduces the requirement of ephedrine and shivering. SN - 0259-1162 UR - https://www.unboundmedicine.com/medline/citation/31198257/Effect_of_Intravenous_Ondansetron_on_Spinal_Anesthesia-Induced_Hypotension_and_Bradycardia:_A_Randomized_Controlled_Double-Blinded_Study L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31198257/ DB - PRIME DP - Unbound Medicine ER -