Ondansetron Preloading with Crystalloid Infusion Reduces Maternal Hypotension during Cesarean Delivery

Qun Wang; Lang Zhuo; Ming-Kun Shen; Yan-Yun Yu; Jun-Jing Yu; Meng Wang

doi:10.1055/s-0033-1364189

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2014; 31(10): 913-922
DOI: 10.1055/s-0033-1364189

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ondansetron Preloading with Crystalloid Infusion Reduces Maternal Hypotension during Cesarean Delivery

Autoren

Qun Wang

¹Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
Lang Zhuo

²School of Public Health, Xuzhou Medical College, Xuzhou, China
Ming-Kun Shen

¹Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
Yan-Yun Yu

¹Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
Jun-Jing Yu

¹Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
Meng Wang

¹Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China

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.

Keywords

ondansetron - hypotension - spinal anesthesia - cesarean delivery

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Referenzen

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
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
3 Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using?. Curr Opin Anaesthesiol 2006; 19 (3) 238-243
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
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
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
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
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
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
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
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
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
13 Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 2003; 98 (5) 1250-1260
14 Martinek RM. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Can J Anaesth 2004; 51 (3) 226-230
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
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
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
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
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
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
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
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
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
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