Effect of Ondansetron on Blood Pressure during Elective Cesarean Section under Spinal Anesthesia at Baghdad Teaching Hospital

2021 ◽  
Vol 1 ◽  
pp. 36-41
Author(s):  
Mustafa Adnan Abdalrahman ◽  
Hassan Mohammed Abbas ◽  
Iyad Abbas Salman
Keyword(s):  
Placebo Group ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Teaching Hospital ◽  
Vital Signs ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Severe Hypotension ◽  
Medical City ◽  
Elective Cesarean

Background: Hypotension is a very common consequence of the sympathetic vasomotor block caused by spinal anesthesia for caesarean section. Maternal symptoms such as nausea, vomiting and dyspnea frequently accompany severe hypotension, and adverse effects on the fetus, including depressed Apgar scores and umbilical acidosis, have been correlated with severity and duration of hypotension. Aim: To investigate the effect of Ondansetron use on the prevention of hypotension and the amount of vasopressor needed to control the hypotension after spinal anesthesia. Methods: This is a prospective double blind, randomized trial carried out in Obstetric Operation room of Baghdad Teaching Hospital, Medical city, Iraq from November, 2018 to August, 2019. Total number of 128 women assessed for eligibility and only 87 were included and allocated into 2 groups. The Ondansetron group (45 women) received 6 mg Ondansetron IV e min before induction of spinal anesthesia. The Placebo group received 3 ml normal saline as placebo before induction. The number of rescue drugs (vasopressors, antiemetic, anti-shivering), vital signs and side effects were recorded each 3 minutes from baseline to 45th minute. Results: The incidence of hypotension, nausea, vomiting and the need for vasopressors and metoclopramide were significantly lower in Ondansetron group than placebo group (p = 0.001, 0.02, 0.003, < 0.001, and 0.001, respectively). Shivering and the need of pethidine for treating this side effect was non significantly lower in ondansetron group than placebo group. Conclusions: The preoperative administration of Ondansetron in cesarean section reduces the risk of spinal anesthesia-induced hypotension, prevents the nausea and vomiting attacks and decreases the need to vasopressors and metoclopramide. Keywords: Spinal anesthesia, caesarian section, ondansetron, hypotension

scholarly journals Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

2016 ◽  
Vol 5 (1) ◽  
pp. 13-18
Author(s):  
Pouran Hajian ◽  
Bita Malekianzadeh ◽  
Maryam Davoudi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Controlled Clinical Trial ◽  
Sterile Water ◽  
Elective Cesarean

Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron  given  intravenously  with  antiemetic  dose  (4  mg)  decreases  mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

scholarly journals Case report: Spinal anesthesia for cesarean section in a parturient with Potocki-Lupski syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junfeng Li ◽  
Jie Bao ◽  
Di Zhang ◽  
Shuzhen Zhou
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Preoperative Evaluation ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Good Prognosis ◽  
Elective Cesarean Section ◽  
Elective Cesarean ◽  
History Of ◽  
Anesthesia Level

Abstract Background Potocki -Lupski syndrome is an uncommon disorder caused by a micro-duplication in chromosome 17p11.2. Variable clinical manifestations bring troubles to the general and neuraxial anesthesia, including mental retardation, facial dysmorphisms, structural cardiovascular anomalies, scoliosis, and malignant hyperthermia. Until now, the anesthesia management for cesarean section in these patients has not been reported yet. Case presentation Here we present a 23-year-old Chinese parturient with Potocki -Lupski syndrome who underwent elective cesarean section under spinal anesthesia. She was transferred to our hospital in her 40th week of gestation. She had a history of IgA nephropathy for more than three years and was diagnosed with Potocki -Lupski syndrome (17p12p11.2 segment 3.1 Mb repeat) in the 29th week of pregnancy. Amniocentesis showed the fetus had no abnormal autosomes. Preoperative multidisciplinary consultation suggested that she should terminate the pregnancy as soon as possible. She was ASA II. Her BMI was 26.43 kg/m2. Her airway evaluation was normal. Her spine could bend well and her spinal interspace could be touched clearly. We did the single spinal anesthesia at L2-3 interspace and gave 0.5% bupivacaine 1.7 ml. The absolute anesthesia level reached T8. The Apgar score for the newborn infant was 10 for 1st minute, 5th minute, and 10th minute. The vital signs were steady without using any vasoactive drugs. The patient had a good prognosis, and was subsequently discharged from hospital. Conclusion To date, the case may be the first reported spinal anesthesia for the parturient with Potocki -Lupski syndrome. Although its manifestations are variable, the spinal anesthesia is feasible under careful and comprehensive preoperative evaluation.

scholarly journals Effectiveness of Leg Elevation to Prevent Spinal Anesthesia-Induced Hypotension during Cesarean Delivery in the Resource-Limited Area: Open Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Sofia Assen ◽  
Bedru Jemal ◽  
Adane Tesfaye
Keyword(s):  
Randomized Controlled Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Controlled Trial ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Limited Area ◽  
Randomized Controlled ◽  
Severe Hypotension ◽  
Elective Cesarean

Background. Postspinal hypotension is the most common complication after spinal anesthesia for cesarean section (CS). Hypotension mainly occurs due to the reductions of vascular tone leading to decreased systemic vascular resistance and decreased venous return. The aim of this study was to assess the effectiveness of leg elevation (LE) as a method of prevention of postspinal hypotension in patients who undergo cesarean section under spinal anesthesia. Methods. This is a single-center parallel-randomized controlled trial study, and 52 full-term parturients scheduled for elective cesarean section who meets inclusion criteria were included in the study. The randomization sequence was created by a researcher not participating in patient management using a computer random generator. The participant was randomly assigned to the leg elevation group (n = 26) or to the control group (n = 26) of usual perioperative care. Results. The proportions of patients who develop hypotension are lower (8 (33.3%)) in the leg elevation group than the control group (15 (62.5%)) with an X2 (1, N = 48) = 4.09, P=0.043. The relative risk of developing postspinal hypotension in the leg elevation group compared to the control group was 0.47 (95% CI, 0.28–1.00). The proportion of severe hypotension was significantly decreased in the leg elevation group at a P value of 0.02. Conclusion. Performing leg elevation immediately after spinal anesthesia reduced the incidence of hypotension. The trial is registered with PACTR201908713181850.

scholarly journals The effect of clonidine with bupivacaine on perioperative hemodynamics and post-operative analgesia in cesarean section cases

2021 ◽  
Vol 10 (8) ◽  
pp. 3049
Author(s):  
Priti Kumar ◽  
Sangeeta Arya ◽  
Sushil Kr. Singh ◽  
Sunil Kumar
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Intraoperative Hypotension ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover. 

Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Demographic Data ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Group A ◽  
Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

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