Effect of prophylactic combination of glycopyrrolate, ondansetron, and ephedrine upon hypotension during obstetric spinal anaesthesia–A randomised controlled trial

Vadhanan, Prasanna; Kalyanasundaram, Cheran; Sundaram, Subbulakshmi; Rajendran, Iniya; Rajasekar, Preethipriyadarshini

doi:10.4103/ija.ija_870_21

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…However, it could be associated with many side effects, especially hypotension. [ 1 ] Many strategies are available to prevent spinal-induced hypotension in CS, especially the use of a low dose of spinal anesthesia associated with adjuvants. [ 2 ] Intrathecal administration of opioids allows reduction of the local anesthetic dose, potentiates analgesic potency, and minimizes potential side effects.…”

Section: Introductionmentioning

confidence: 99%

The effect of adding dexmedetomidine or dexamethasone to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section

Ahmed,

Lotfy,

Mostafa

2024

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine–fentanyl mixture on the postoperative analgesia duration, after elective cesarean section. Material and Methods: This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine–fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 μg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes. Results: As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine–fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups. Conclusion: The use of dexmedetomidine as an additive to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.

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Section: Introductionmentioning

confidence: 99%

The effect of adding dexmedetomidine or dexamethasone to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section

Ahmed,

Lotfy,

Mostafa

2024

Journal of Anaesthesiology Clinical Pharmacology

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“…A number of studies conducted on both non-obstetric [6,7] and obstetric [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] populations suggest that 5-HT may be an important factor associated with cardiovascular responses via the BJR and this effect can be blocked at the 5-HT3 receptor by 5-HT3 receptor antagonists like ondansetron.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial

Vashishth¹,

Lal²,

Bangarwa³

et al. 2022

Cureus

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IntroductionSpinal anaesthesia is frequently associated with adverse effects like maternal hypotension and bradycardia. This effect is due to a decrease in systemic vascular resistance, a decrease in central venous pressure or Bezold-Jarisch Reflex (mediated by 5-HT3 receptors). We aimed to measure the effect of three different doses of prophylactic intravenous ondansetron (5-HT3 antagonists) with a placebo on maternal haemodynamics. MethodsA prospective randomised control study was done over 240 parturients, aged 19-35 years. They were randomly allocated into four groups (n=60) Group O4, Group O6, Group O8 and Group S to receive either intravenous ondansetron 4 mg, 6 mg, 8 mg or 0.9% normal saline respectively. Haemodynamic variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate [HR]) were recorded at 2-minute intervals for the first 20 minutes and at 5-minute intervals for further 30 minutes. ResultsA significant decrease in haemodynamic parameters was observed in group S when compared with ondansetron groups at various time intervals (p<0.05). The difference was most significant in groups O6 and O8. Development of nausea and vomiting was significantly higher in Group S compared to ondansetron groups (p< 0.005). The requirement for ephedrine was more in Group S in comparison to ondansetron groups (p<0.0001). ConclusionAll three groups of ondansetron showed a decrease in the incidence of hypotension and use of vasopressor but Group O6 and O8 were more effective in attenuating spinal-induced hypotension in parturients undergoing caesarean section.

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Crystalloid Preloading versus Prophylactic Ephedrine Infusion for Prevention of Hypotension during Caesarean Section

Sathyavrdhan,

Kamath

2024

Journal of Obstetric Anaesthesia and Critical Care

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Context: Central neuraxial blockade is widely practiced in obstetric anesthesia. The prevention of maternal systemic hypotension is of importance. Aim: To compare between crystalloid preloading and prophylactic intravenous ephedrine in the prevention of maternal systemic hypotension after spinal anesthesia for cesarean section. Settings and Design: Study was conducted in a tertiary care hospital; comparative observational study. Methods and Materials: One hundred fifty six healthy parturients, posted for elective cesarean section. The parturients who were preloaded with 10 mL/kg of Ringer Lactate over 20 minutes before spinal anesthesia by treating anesthesiologist were included in Group P. Parturients were administered prophylactic ephedrine 0.125 mg/kg infusion after spinal anesthesia at the onset of sympathetic block by treating anesthesiologist were included in Group E. Statistical Analysis Used: Data were entered in Microsoft excel and analyzed using SPSS software version 25 (IBM). Results: In our study, we found that fall in blood pressure was statistically significant from fourth to 14th minute in Group P compared to Group E. The mean arterial pressure became significantly low in Group P compared to Group E. Heart rate was found to increase in Group P from second minute compared to sixth minute in Group E. Fetal wellbeing assessed by appearance (colour), pulse, grimace (response to touch), activity (tone) and respiration (APGAR) score was better in Group E compared to Group P and was statistically significant. Nausea and vomiting were more in Group P compared to Group E and was statistically significant. Conclusions: We conclude that prophylactic ephedrine infusion has better control over maternal hemodynamic than crystalloid preloading in cesarean section under spinal anesthesia.

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Effect of prophylactic combination of glycopyrrolate, ondansetron, and ephedrine upon hypotension during obstetric spinal anaesthesia–A randomised controlled trial

Cited by 4 publications

References 16 publications

The effect of adding dexmedetomidine or dexamethasone to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section

The effect of adding dexmedetomidine or dexamethasone to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section

Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial

Crystalloid Preloading versus Prophylactic Ephedrine Infusion for Prevention of Hypotension during Caesarean Section

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