The Use of Ondansetron in Reducing Hypotension After Spinal.

Often times, we have to deal with HOTN after spinal placed in obstetric patients. Patient may feel nauseated and throw up due to HOTN. Besides co-loading of crystalloid, ondansetron can be given 5-15mins prior to spinal placement to reduce the extend of HOTN. It is a cheap and readily available drug in our anesthesia cart.

why it works:

  • 5-HT3 antagonist
  • MOA – blocks serotonin at central & peripheral 5-HT3 receptors notably at CTZ and vagal afferents pathway.
  • In the presence of decreased blood volume, 5-HT may be an important factor inducing the Bezold-Jarish Reflex via 5-HT3 receptors.
  • Ondansetron attenuates the 5-HT3 mediated vagal responses associated with spinal.

Evidence based studies to support the findings:

  • Sahoo et al (Int J Obstet Anesth 2010): RCT demonstrated 4mg IV given 5 mins prior to spinal placement significantly reduces the amount of pressors used in elective C-section.
  • Owczuk et al (Reg Anesth Pain Med, 2008): RCT demonstrated that ondansetron given IV attenuates arterial blood pressure drop due to spinal anesthesia

 

Try it out and let me know what you think.

One Comment Add yours

  1. Cathleen says:

    I am forever indebted to you for this inftimaoron.

    Like

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