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Anesth Essays Res. 2019 Apr-Jun;13(2):340-346. doi: 10.4103/aer.AER_22_19.

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

Author information

1
Department of Anaesthesiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India.
2
Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India.
3
Department of Anaesthesiology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India.

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.

KEYWORDS:

Bezold–Jarisch reflex; ondansetron; spinal anesthesia

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