Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.028
Brazilian Journal of Anesthesiology
Clinical Research

Effect of ondansetron on spinal anesthesia-induced hypotension in non-obstetric surgeries: a randomised, double-blind and placebo-controlled trial

Efeito da ondansetrona na hipotensão induzida por raquianestesia em cirurgias não obstétricas: estudo randomizado, duplo-cego e controlado com placebo

Fabrício Tavares Mendonça, Luis Carlos Crepaldi Júnior, Rafaela Carvalho Gersanti, Kamila Christine de Ara[ujo

Downloads: 1
Views: 118

Abstract

Background and objectives
Spinal anesthesia is an effective technique for many surgical procedures, but it is often associated with an increased risk of potentially deleterious hemodynamic disturbances. The benefits of prophylactic ondansetron for preventing spinal anesthesia-induced hypotension are still uncertain. Therefore, this study aimed to compare the effect of ondansetron and placebo before spinal block on the incidence of hypotension in patients having non-obstetric surgeries.

Methods
Randomized, double-blind, parallel-group, superiority trial with a 1:1 allocation ratio. A total of 144 patients scheduled for non-obstetric surgeries with an indication for spinal anesthesia were randomized. Patients received intravenous ondansetron (8 mg) or placebo before standard spinal anesthesia. The primary outcome was the rate of hypotension in the first 30-minutes after spinal anesthesia.

Results
Hypotension occurred in 20 of 72 patients (27.8%) in the ondansetron group and in 36 of 72 patients (50%) in the placebo group (Odds Ratio–OR = 0.38; 95% Confidence Interval–95% CI 0.19 to 0.77; p = 0.007). Fewer patients in the ondansetron group required ephedrine compared to the placebo group (13.9% vs. 27.8%; OR = 0.42; 95% CI 0.18 to 0.98; p = 0.04). Exploratory analyses revealed that ondansetron may be more effective than placebo in patients aged 60-years or older (OR = 0.12; 95% CI 0.03 to 0.48; p = 0.03). No difference in heart rate variations was observed.

Conclusion
Our findings suggest that ondansetron can be a viable and effective strategy to reduce both the incidence of spinal anesthesia-induced hypotension and vasopressors usage in non-obstetric surgeries.

Keywords

Elderly;  Hypotension;  Ondansetron;  Spinal anesthesia

References

[1] R.L. Carpenter, R.A. Caplan, D.L. Brown, et al. Incidence and risk factors for side effects of spinal anesthesia Anesthesiology., 76 (1992), pp. 906-916

[2] S.S. Liu, S.B. McDonald Current issues in spinal anesthesia Anesthesiology., 94 (2001), pp. 888-906

[3] A.S. Terkawi, D. Mavridis, P. Flood, et al. Does ondansetron modify sympathectomy due to subarachnoid anesthesia?.: meta-analysis, meta-regression, and trial sequential analysis Anesthesiology., 124 (2016), pp. 846-869

[4] I.D.F. Pereira, M.M. Grando, P.T.G. Vianna, et al. Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP Rev Bras Anestesiol., 61 (2011), pp. 574-581

[5] J.A. Campagna, C. Carter Clinical relevance of the Bezold-Jarisch reflex Anesthesiology., 98 (2003), pp. 1250-1260

[6] M. Heesen, M. Klimek, S.E. Hoeks, et al. Prevention of spinal anesthesia-induced hypotension during cesarean delivery by 5-hydroxytryptamine-3 receptor antagonists: a systematic review and meta-analysis and meta-regression Anesth Analg., 123 (2016), pp. 977-988

[7] R. Owczuk, W. Wenski, P. Twardowski, et al. Ondansetron attenuates the decrease in blood pressure due to spinal anesthesia in the elderly: a double blind, placebo-controlled study Minerva Anestesiol., 81 (2015), pp. 598-607

[8] K. Kashihara Roles of arterial baroreceptor reflex during bezold-jarisch reflex Curr Cardiol Rev., 5 (2009), pp. 263-267

[9] M. Walsh, P.J. Devereaux, A.X. Garg, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension Anesthesiology., 119 (2013), pp. 507-515

[10] M.B. Tyers, A.J. Freeman Mechanism of the anti-emetic activity of 5-HT3 receptor antagonists Oncology., 49 (1992), pp. 263-268

[11] R. Owczuk, W. Wenski, A. Polak-Krzeminska, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study Reg Anesth Pain Med., 33 (2008), pp. 332-339

[12] M. Wang, L. Zhuo, Q. Wang, et al. Efficacy of prophylactic intravenous ondansetron on the prevention of hypotension during cesarean delivery: a dose-dependent study Int J Clin Exp Med., 7 (2014), pp. 5210-5216

[13] W. Trabelsi, C. Romdhani, H. Elaskri, et al. Effect of ondansetron on the occurrence of hypotension and on neonatal parameters during spinal anesthesia for elective caesarean section: a prospective, randomized, controlled, double-blind study Anesthesiol Res Pract., 2015 (2015), p. 158061

[14] M. Golparvar, M. Saghaei, M.A. Saadati, S. Farsaei Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: A randomized, double-blind placebo-controlled clinical trial Saudi J Anaesth., 9 (2015), pp. 365-369

[15] M.J.C. Carmona, C.M. Simões Paciente 4.0–O desafio do cuidado aos pacientes muito idosos Rev Bras Anestesiol., 70 (2020), pp. 1-2

[16] G.J. Crystal, M.R. Salem The Bainbridge and the “Reverse” Bainbridge Reflexes: History Physiology, and Clinical Relevance. Anesth Analg., 114 (2012), pp. 520-532

[17] L.S. Urzedo-Rodrigues, H.S. Ferreira, D.O. Almeida, et al. Blockade of 5-HT3 receptors at septal area increase blood pressure in unanaesthetized rats Auton Neurosci., 159 (2011), pp. 51-61

[18] S.M. Kinsella, J.P. Tuckey Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex Br J Anaesth., 86 (2001), pp. 859-868

[19] K. Raghu, S. Kumar, G. Rajaram, et al. Effect of ondansetron in the prevention of spinal anesthesia-induced hypotension J Sci Soc., 45 (2018), p. 125

[20] O. Lairez, F. Ferré, N. Portet, et al. Cardiovascular effects of low-dose spinal anaesthesia as a function of age: An observational study using echocardiography Anaesth Crit Care Pain Med., 34 (2015), pp. 271-276

[21] J. Wu, S. Xia, B. Kalionis, W. Wan, T. Sun The Role of Oxidative Stress and Inflammation in Cardiovascular Aging Biomed Res Int. (2014), p. 2014

[22] K.D. Monahan Effect of aging on baroreflex function in humans Am J Physiol Regul Integr Comp Physiol., 293 (2007), pp. R3-R12

[23] B.D. Alvis, C.G. Hughes Physiology considerations in geriatric patients Anesthesiol Clin., 33 (2015), pp. 447-456

[24] T. Wehrum, T. Lodemann, P. Hagenlocher, et al. Age-related changes of right atrial morphology and inflow pattern assessed using 4D flow cardiovascular magnetic resonance: results of a population-based study J Cardiovasc Magnetic Res., 20 (2018), p. 38

[25] M.M. Rashad, M.S. Farmawy Effects of intravenous ondansetron and granisetron on hemodynamic changes and motor and sensory blockade induced by spinal anesthesia in parturients undergoing cesarean section Egypt J Anaesth., 29 (2013), pp. 369-374

[26] A. Marciniak, R. Owczuk, M. Wujtewicz, et al. The influence of intravenous ondansetron on maternal blood haemodynamics after spinal anaesthesia for caesarean section: a double-blind, placebo-controlled study Ginekol Pol., 86 (2015), pp. 461-467

[27] C.M. Tatikonda, G.C. Rajappa, P. Rath, et al. Effect of intravenous ondansetron on spinal anesthesia-induced hypotension and bradycardia: a randomized controlled double-blinded study Anesth Essays Res., 13 (2019), pp. 340-346

[28] E.D. Figueredo, L.G. Canosa Ondansetron in the prophylaxis of postoperative vomiting: a meta-analysis J Clin Anesth., 10 (1998), pp. 211-221

[29] F. Cox Systematic Review of Ondansetron for the Prevention and Treatment of Postoperative Nausea and Vomiting in Adults Brit J Theat Nurs., 9 (1999), pp. 556-566

[30] A. Bataille, J.-F. Letourneulx, A. Charmeau, et al. Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anaesthesia: A randomised double-blind placebo-controlled study Eur J Anaesthesiol., 33 (2016), pp. 898-905
 

605e2e5ba9539507453544d4 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections