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Background
A consequence of spinal anesthesia is hypotension requiring vasopressor administration, which is undesirable for both the mother and fetus
The Bezold-Jarisch reflex has been thought to induce bradycardia/hypotension after spinal anesthesia. This reflex is mediated by serotonin receptors
The use of prophylactic ondansetron may reduce the incidence of spinal-induced hypotension in parturients undergoing cesarean section
Evidence
Evidence from two systematic reviews and two RCTs consistently found that prophylactic ondansetron use prior to spinal anesthesia:
Reduced the incidence of spinal-induced hypotension in parturients undergoing spinal anesthesia
Attenuated the decrease in SBP, MAP, and DBP & reduced the use of vasopressors
Forest plot for mean ephedrine consumption during surgery: prophylactic ondansetron administration vs. placebo. Reference
Forest plot for mean phenylephrine consumption during surgery: prophylactic ondansetron administration vs. placebo. Reference
Forest plot for the incidence of spinal anesthesia-induced hypotension: prophylactic ondansetron administration vs. placebo. Reference
Forest plot for the incidence of spinal anesthesia-related bradycardia: prophylactic ondansetron administration vs. placebo. Reference
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