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Background: Subarachnoid block (SAB) or spinal anaesthesia is the most commonly used anaesthesia technique for conducting caesarean section. Although subarachnoid block is considered safe, it is associated with high risk of hypotension specially in elective caesarean section. The selective 5-hydroxytrptamine-3 (5-HT3) receptors are also present peripherally in the form of cardiac chemoreceptors on sensory component of vagal nerve endings and also in the wall of right and left ventricles. So, action of serotonin on these 5-HT3 receptors results in decrease in blood pressure and heart rate. Aim/Objective: To assess the efficacy and safety of intravenous granisetron in prevention of hypotension and bradycardia following spinal anaesthesia in parturients undergoing lower segment caesarean section (LSCS). Materials and method: Parturients were randomized into two groups using a web generated random number. Granisetron group patients received IV Granisetron 1mg and Saline group patients received IV 5ml of 0.9% normal saline. Both the groups received the allocated drug solution intravenously 10 minutes before administration of SAB. A fall in the systolic blood pressure below 100mmHg or a fall in mean arterial blood pressure of more than 20% from baseline was considered as hypotension and managed with 6mg bolus of intravenous mephenteramine. Results: More events of hypotension were observed in saline group (74%) than granisetron group (34%) with statistically significant difference (p<0.05). Mephentermine was used more frequently than in saline group as compared to granisetron group. Atropine was not required in either patient. No significant difference between two groups was recorded with respect to height of sensory block (p>005). Similarly, both groups were comparable with respect to duration of surgery, intra-operative and post-operative complications. Conclusion: Our study results showed that granisetron is effective in decreasing incidence of hypotension in parturients undergoing elective caesarean section under spinal anaesthesia in addition to its anti-emetic effect which is its main indication without any risk of significant intra-operative or post-operative negative outcomes.

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Patients with different manifestations and different diagnoses are admitted in Paediatric department. In admitted cases, drug therapy usually consists of multiple drugs including antibiotics, anticoagulants, glucocorticoids, antihypertensive, anti-diabetics, etc. Due to the prescription of multiple drugs, the chance of drug interactions is high. Early detection of DRP can help prevent any harm to patients. It is therefore possible to thoroughly evaluate various drug-related problems and prevent some of them in the paediatric inpatient department. The aim was to find out the drug-related problems during management of patients under paediatric department, to find out the magnitude and preventability. In addition, we hoped to provide insights into the DRPs encountered among hospitalized paediatric patients that can help in finding the appropriate solutions. All children's medical records were identified, collected and analyzed by trained clinical pharmacologists to identify DRP according to the well recognized and appropriate criteria system established by the Pharmaceutical Care Network Europe (PCNE). For standardization, patient demographics (age, gender, location and diagnosis) were recorded using WHO ICD version. Drugs were grouped into different categories using the Anatomic Therapeutic Chemical (ATC) classification (WHO-ATC). Descriptive analysis was done to summarize the findings of this study. Of 534 patients, 193 patients (36.1%, 193/534) had at least one DRP. A total of 262 DRPs were identified in 193 patients, of which 230 DRPs (87.8%, 230/262) were considered preventable. he vast majority of DRPs were related to dose selection (74.78%, 172/230). The second most common cause was related to drug choice (23.04%, 53/230) and drug use (2.5%, 5/280). We found that an increase in the number of drugs also increases the chances of having DRP by 1.31 times (95% CI, 0.89 to1.81, P=0.00005). There is high incidence of preventable drug related problems which is generally ignored if not thoroughly investigated. Most of the DRPs are associated with dosing and drug choice problems.