Prophylactic Ondansetron to Attenuate Spinal-Induced Hypotension in Parturients Undergoing Cesarean Section

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