Minimal effective weight-based dosing of ondansetron to reduce hypotension in cesarean section under spinal anesthesia: a randomized controlled superiority trial

Oofuvong, Maliwan; Kunapaisal, Thitikan; Karnjanawanichkul, Orarat; Dilokrattanaphijit, Nussara; Leeratiwong, Jaranya

doi:10.1186/s12871-018-0568-7

Cited by 25 publications

(27 citation statements)

References 23 publications

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“…Similarly, Ortiz et al 7 compared 2, 4, and 8 mg of ondansetron with a placebo and found that ondansetron had no pharmacological effect on reducing the incidence of spinal-induced hypotension or the amounts of vasopressor used in cesarean delivery. Oofuvong et al 8 tried to find the minimal effective dose of ondansetron that would prevent spinal-induced hypotension, but failed to observe this effect. It is difficult to explain the inconsistencies observed in these previously published reports.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] However, there is some controversy surrounding this function of ondansetron. [6][7][8] Different research conditions used in different studies may contribute to this controversy, such as the dose of ondansetron that was used and the timing of administration. Studies have already suggested that 4 mg of ondansetron is more effective in this context compared to other doses.…”

Section: Introductionmentioning

confidence: 99%

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<p>Does an Earlier or Late Intravenous Injection of Ondansetron Affect the Dose of Phenylephrine Needed to Prevent Spinal-Anesthesia Induced Hypotension in Cesarean Sections?</p>

Qian

Zheng

et al. 2020

DDDT

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Background: There was controversy about ondansetron can reduce the incidence of spinalinduced hypotension and decrease the consumption of vasopressor in cesarean delivery with spinal anesthesia. We hypothesized that different timing of ondansetron administration may contribute to the controversy. Therefore, we aimed to determine the effect of different timing of ondansetron administration on the dose requirement of preventing phenylephrine via comparing the ED 50 of prophylactic phenylephrine. Methods: Seventy-five parturients were finally enrolled in this prospective, randomized, double-blinded dose finding study. Ondansetron or placebo was administered 5 min or 15 min before intrathecal injection. Up-down allocation method was used to determine the dose of prophylactic phenylephrine for each parturient in the three groups. The initial infusion rate of first patient was 0.5 µg/kg/min. Then, the rate for next patient was varied with increasing or decreasing of 0.05 μg/kg/min according to the response of the previous patient. An effective dose was defined as no hypotension occurred during the study period. An ineffective dose was defined as hypotension occurred during the study period. Study period in this study is from intrathecal injection to neonatal delivery. ED 50 of phenylephrine infusion was calculated by probit regression. Results: The ED 50 of intravenous phenylephrine calculated by probit analysis was 0.33 (95% CI 0.20 to 0.38) µg/kg/min and 0.36 (95% CI 0.32 to 0.38) µg/kg/min in group A and B, and 0.41 (95% CI 0.37 to 0.44) µg/kg/min in group C for patients undergoing cesarean delivery with combined spinal-epidural anesthesia. Conclusion: An earlier administration of 4 mg prophylactic ondansetron contributed no benefits for lowing the dose of prophylactic phenylephrine compared to a late administration, but can decrease the dose of preventing phenylephrine in patients undergoing cesarean delivery with combined spinal-epidural anesthesia. This finding may be useful for clinical practice and further studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Does an Earlier or Late Intravenous Injection of Ondansetron Affect the Dose of Phenylephrine Needed to Prevent Spinal-Anesthesia Induced Hypotension in Cesarean Sections?</p>

Qian

Zheng

et al. 2020

DDDT

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“…Hypotension is the most common problem associated with spinal anesthesia, and treatment for hypotension is more likely when this method is used 18,19 . The incidences of hypotension during spinal anaesthesia for cesarean section reported vary from 53 to 85% worldwide 20 . The possible mechanism of subarachnoid block-induced hypotension is related to spinal nerve sympathectomy, vasodilation of peripheral arteries, decreased venous reflux, and consequently decreased cardiac output 21 .…”

Section: Discussionmentioning

confidence: 99%

Intravertebral Anaesthesia For cesarean section

Wang

Xie

Chun

et al. 2019

Preprint

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BACKGROUND: Although epidural and spinal anaesthesia in patients undergoing cesarean section is the general choice recently, both of the two anesthesia methods still have imperfects. Caudal anesthesia has been considered more appropriate for gynecological surgery. However, there is a lack of experiments on the effects of epidural block combined with caudal block anaesthesia for cesarean section. METHODS: One hundred and fifty patients undergoing elective cesarean section were recruited to this clinical trial and randomized to receive epidural block, subarachnoid block, and epidural block combined with caudal block. The primary objective was to compare and evaluate the clinical efficacy of three groups. Secondary outcomes included side effects and the quality of intraoperative and postoperative comfort assessment. RESULTS: The times to cryanaesthesia at T10 and time to maximum motor block were shorter in group SAB. The maximal sensory blockade spinal segments of group SAB(15.18±0.90)and EAC (14.74±1.16)were much more than group EPB(10.74±1.77). Compared to group EPB(155.40±13.28) and EAC(160.70±12.58), the duration of complete regression of motor block was longer in group SAB(190.00±13.25). The intraoperative quality of anesthesia was judged by the gynecologist was excellent in group EAC and SAB(P=0.005), and by the parturients was only best in group EAC(P=0.001). The parturients felt more comfortable after surgery in group EPB and group EAC(P=0.007). CONCLUSIONS: Epidural block combined with caudal block anaesthesia can achieve the same anesthetic effect as spinal anaesthesia which is bettter than epidural anaesthesia for elective cesarean section, and have the highest level of intraoperative and postoperative comfort for parturient.

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“…Post-spinal anesthesia hypotension, which can occur as a result of combined spinal epidural (CSE) anesthesia during cesarean delivery, can lead to adverse maternal and fetal outcomes. [1][2][3][4] Therefore, effective prediction of maternal hypotension is of great clinical importance.…”

Section: Introductionmentioning

confidence: 99%

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery.

Yao

Zhao

Zheng

et al. 2020

Preprint

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Background: Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. The aim of this study was to assess whether peak velocity and diameter of IVC below the xiphoid or the right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension. Methods: After ultrasound measurement of peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV before anesthesia, 56 parturients undergoing elective cesarean section with spinal anesthesia were enrolled in this study. Hypotension was defined as having a drop of systolic arterial pressure >20% from the baseline. The primary outcome was ultrasound measurements of IVC and RCFV, and their association with post-spinal hypotension during cesarean delivery. Multinomial logistic regression analysis was used to identify the association between the measurements of ICV, RCFV and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension, and the areas under the curve and the optimum cut-off values for the predictive parameters were calculated. Results: Longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (0.628–0.890; P = 0.001). A transverse diameter of the RCFV >12.2 mm could predict post-spinal hypotension during cesarean delivery. Conclusions: We demonstrated a longer transverse diameter of RCFV was associated with hypotension and it could predict parturients at major risk of hypotension before anesthesia.

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Minimal effective weight-based dosing of ondansetron to reduce hypotension in cesarean section under spinal anesthesia: a randomized controlled superiority trial

Cited by 25 publications

References 23 publications

<p>Does an Earlier or Late Intravenous Injection of Ondansetron Affect the Dose of Phenylephrine Needed to Prevent Spinal-Anesthesia Induced Hypotension in Cesarean Sections?</p>

<p>Does an Earlier or Late Intravenous Injection of Ondansetron Affect the Dose of Phenylephrine Needed to Prevent Spinal-Anesthesia Induced Hypotension in Cesarean Sections?</p>

Intravertebral Anaesthesia For cesarean section

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery.

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