Ondansetron Preloading with Crystalloid Infusion Reduces Maternal Hypotension during Cesarean Delivery

 

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Abstract

Objective The aim of the article was to investigate the effect of ondansetron preloading with crystalloid infusion after spinal anesthesia during cesarean delivery.

Study Design A total of 66 parturient women scheduled for elective caesarean sections were randomly assigned to two groups. Five minutes before spinal anesthesia, Group O patients were injected with 4 mg of ondansetron, while Group S patients were injected with 5 mL physiological saline. Maternal blood pressure and heart rate were measured at 2 minute intervals for 30 minutes. After delivery, umbilical cord blood samples were analyzed.

Results Maternal hypotension and nausea were significantly lower in ondansetron-treated patients versus placebo (p = 0.011 vs. 0.004). Umbilical venous pH was significantly higher in ondansetron-treated patients (p = 0.006), while partial pressure of carbon dioxide (Pco ₂) was significantly lower (p = 0.002). Decreases in maternal systolic and mean arterial blood pressures were significantly lower in ondansetron-treated patients (p = 0.008 vs. 0.025), with less requirement for phenylephrine administration compared with controls (p = 0.029).

Conclusion Ondansetron preloading combined with crystalloid infusion significantly reduced hypotension and nausea, while improving acid–base status, as well as reducing vasoconstrictor use.

• References

• 1 Macarthur A, Riley ET. Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin 2007; 45 (1) 115-132
  CrossrefPubMedGoogle Scholar
• 2 Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2012; 114 (2) 377-390
  CrossrefPubMedGoogle Scholar
• 3 Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using?. Curr Opin Anaesthesiol 2006; 19 (3) 238-243
  CrossrefPubMedGoogle Scholar
• 4 Mohta M, Janani SS, Sethi AK, Agarwal D, Tyagi A. Comparison of phenylephrine hydrochloride and mephentermine sulphate for prevention of post spinal hypotension. Anaesthesia 2010; 65 (12) 1200-1205
  CrossrefPubMedGoogle Scholar
• 5 Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Int J Obstet Anesth 2012; 21 (1) 24-28
  CrossrefPubMedGoogle Scholar
• 6 Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth 1992; 68 (4) 394-397
  CrossrefPubMedGoogle Scholar
• 7 Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993; 79 (2) 262-269
  CrossrefPubMedGoogle Scholar
• 8 Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 1995; 75 (3) 262-265
  CrossrefPubMedGoogle Scholar
• 9 Kamenik M, Paver-Erzen V. The effects of lactated Ringer's solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg 2001; 92 (3) 710-714
  CrossrefPubMedGoogle Scholar
• 10 Ewaldsson CA, Hahn RG. Volume kinetics of Ringer's solution during induction of spinal and general anaesthesia. Br J Anaesth 2001; 87 (3) 406-414
  CrossrefPubMedGoogle Scholar
• 11 Dyer RA, Farina Z, Joubert IA , et al. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care 2004; 32 (3) 351-357
  PubMedGoogle Scholar
• 12 American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007; 106 (4) 843-863
  CrossrefPubMedGoogle Scholar
• 13 Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 2003; 98 (5) 1250-1260
  CrossrefPubMedGoogle Scholar
• 14 Martinek RM. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Can J Anaesth 2004; 51 (3) 226-230
  CrossrefPubMedGoogle Scholar
• 15 Aviado DM, Guevara Aviado D. The Bezold-Jarisch reflex. A historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci 2001; 940: 48-58
  PubMedGoogle Scholar
• 16 Velken R, Swain LL, Di Bona GF. Epidural serotonin receptors in circulatory control in conscious Sprague-Dawley rats. Am J Physiol 1990; 258: H468-H472
  PubMedGoogle Scholar
• 17 Yamano M, Kamato T, Nishida A , et al. Serotonin (5-HT)3-receptor antagonism of 4,5,6,7-tetrahydrobenzimidazole derivatives against 5-HT-induced bradycardia in anesthetized rats. Jpn J Pharmacol 1994; 65 (3) 241-248
  CrossrefPubMedGoogle Scholar
• 18 Mark AL. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol 1983; 1 (1) 90-102
  CrossrefPubMedGoogle Scholar
• 19 Gan TJ, Meyer T, Apfel CC , et al; Department of Anesthesiology, Duke University Medical Center. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97 (1) 62-71
  PubMedGoogle Scholar
• 20 Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Curr Opin Anaesthesiol 2006; 19 (6) 606-611
  CrossrefPubMedGoogle Scholar
• 21 Kelsaka E, Baris S, Karakaya D, Sarihasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med 2006; 31 (1) 40-45
  PubMedGoogle Scholar
• 22 Owczuk R, Wenski W, Polak-Krzeminska A , et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med 2008; 33 (4) 332-339
  PubMedGoogle Scholar
• 23 Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 2002; 97 (6) 1582-1590
  CrossrefPubMedGoogle Scholar
• 24 Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai 2008; 91 (2) 181-187
  PubMedGoogle Scholar