Dose Of Ondansetron Research Articles

The Effect of Multi-Dose Ondansetron on the Vomiting Associated with Acute Gastroenteritis in Children Less than 5 Years Old

Abstract Background Acute gastroenteritis is a leading cause of emergency department visits and hospitalization among children. Oral rehydration therapy is recommended for children with mild to moderate dehydration, but children who present with vomiting are frequently offered intravenous rehydration in the emergency department. Ondansetron is the only antiemetic agent with consistent, proven efficacy in reducing vomiting from acute gastroenteritis and promote oral rehydration. Aim of the Work To evaluate the effect of multiple doses of ondansetron on the control of vomiting associated with acute gastroenteritis in the children in comparison to a single dose. Patients and Methods This was a randomized controlled study that was conducted on 70 children less than 5 years old presenting to the emergency department of pediatric hospital, Ain Shams University in a period of 6 months with acute gastroenteritis. They were divided into 2 groups (35 patients in each group): Arm one (odd numbers): received single dose of ondansetron (Zofran-intramascular) the dose 0.15mg/kg to a maximum 8 mg. Arm two (even numbers): received (6 doses) of ondansetron (Zofran- intramascular) the dose 0.15mg/kg to a maximum 8 mg every 8 hours for 48hrs. The modified Vesikari scale score was performed at different times as gastroenteritis severity scale. Results Both groups were comparable regarding age, sex, weight and height. There was no statistically significant difference found between group A and group B regarding all parameters of modified Vesikari scale score (MVS) at time of enrollment, at 24 hours, 48 hours and at 7 days with p-value = 0.400, 0.394, 0.451 and 0.746. There was no statistically significant difference found between both groups regarding side effects of ondansetron while there was statistically significant increase in the percentage of patients with diarrhea in group B (17.1%) than group A (0.0%) with p-value = 0.010 Conclusion No significant difference was found between both groups regarding modified Vesikari scale score (MVS) at different times of measurement. Diarrhea was more prevalent in multiple doses of ondansetron than single dose as a side effect.

Use of liposomal bupivacaine in cats undergoing gastrointestinal surgery is associated with lower doses of full µ-opioid agonists postoperatively

Objectives The aim of the study was to analyze the association of the administration of liposomal bupivacaine (Nocita) with postoperative opioid use in cats undergoing gastrointestinal surgery, as well as to analyze the administration of antiemetics postoperatively in this study population to qualify the degree of nausea related to opioid administration. Methods Records of 187 cats undergoing gastrointestinal surgery across two institutions, the Matthew J Ryan Veterinary Hospital at the University of Pennsylvania and the University of Florida Small Animal Hospital, were analyzed for multilayer liposomal bupivacaine infiltration at the time of abdominal closure, postoperative injectable opioid use and postoperative injectable antiemetic use. Results Cats that were administered liposomal bupivacaine at the time of abdominal closure received significantly lower doses of full µ-opioid agonists postoperatively. Significantly more cats that received liposomal bupivacaine were managed with full µ + partial µ-opioid agonists postoperatively than any other opioid profile. Cats that received liposomal bupivacaine received lower doses of ondansetron in hospital compared with cats that did not receive liposomal bupivacaine. Conclusions and relevance This study suggests that in cats requiring analgesia postoperatively, the use of liposomal bupivacaine at closure reduces the use of full µ-opioid agonists postoperatively. In addition, more patients that received liposomal bupivacaine were de-escalated from full µ-opioid agonists to partial µ-opioid agonists during their hospital stay, suggesting that less analgesia was required throughout their hospitalization. Lastly, lower doses of ondansetron, a typical second-line antinausea medication after gastrointestinal surgery, were used in cats that received liposomal bupivacaine, which may suggest less postoperative nausea.

The effect of intravenous ondansetron on QT interval in the emergency department

ObjectiveOndansetron, a 5HT3 receptor antagonist, is commonly used in emergency departments to treat nausea and vomiting. In 2011, the Food and Drug Administration (FDA) issued a warning that this medicine may cause QT prolongation, potentially leading to deadly arrhythmias. The objective of this study was to characterize the QT interval prolongation associated with ondansetron use in the Emergency Department. MethodsThis was a prospective, observational cohort study of adult patients who presented to the emergency department during a one-year period and were treated with intravenous ondansetron. We investigated the QT prolongation associated with dosages. ECGs were obtained before the medication and 5, 15, and 30 minutes after IV drug administration. Every QT measurement was recorded and compared to the zero point. The severity of drug-induced QT prolongation was determined according to the recommendations of the International Conference on Compliance (ICH). QTc prolongation was categorized as ‘negligible’ (<5 ms), ‘significant’ (>20 ms), ‘potential concern’ (>30 ms), or ‘definitely worrying’ (>60 ms). ResultsOf the 435 patients enrolled in the study, 60% (261 patients) were female and the mean age was 39 (±18). The QT prolongation peaked at the fifth minute and remained consistent at the fifteenth and thirty-first minutes. The maximum prolongation of the mean QT duration occured at the fifth minute (7.9 ± 18.1 ms). No patient revealed any problems with cardiac conduction. The prolonged QT interval was not related to the dose of ondansetron, but QT measurements were higher in the 30th minute in patients treated with 8 mg of ondansetron. The effect of ondansetron administration on QT prolongation was found to be above the ‘negligible’ but below the ‘significant’ value, according to the ICH recommendations. DiscussionIn this study, QT prolongation due to ondansetron administration was below the ‘important’ value according to the recommendations of the ICH. No cases of cardiac arrhythmia were reported in any of the partients. Thus, routine ECG monitoring in patients given ondansetron due to the risk of QTc prolongation does not seem cost-effective when evaluated together with additional factors such as its negative impact on emergency patient flow, waste of personnel and time, and increase in healthcare costs. In the absence of a known risk of cardiac arrhythmia, IV administration of 4 mg and 8 mg of ondansetron doses no risk of QT prolongation in the emergency population.

Commentary on Efficacy and Safety of Low dose ondansetron as a prospective precision medicine to treat alcohol use disorder phenotypes

Commentary on Efficacy and Safety of Low dose ondansetron as a prospective precision medicine to treat alcohol use disorder phenotypes

Effect of Ondansetron on Maternal Hypotension During Spinal Anesthesia With Ropivacaine for Cesarean Sections: A Randomized, Double-Blind Trial.

Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, has been proven to be effective in the prevention of spinal-induced hypotension for elective cesarean section. A total of 138primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Groups ONDA4 and ONDA8, respectively, received 4 and 8mgof ondansetron in 100 mL normal saline, before spinal anesthesia with 1.7 mL ropivacaine 0.75% and 15 mcg of fentanyl, whereas the CONTROL group received an equal volume of normal saline. Noninvasive blood pressure and heart rate were recorded upon arrival, before and after spinal injection, and thereafter every minute for a time period of 10 minutes along with total doses of phenylephrine (mcg) or ephedrine (mg). Time required for the spinal anesthesia to achieve a sensory and motor block at the T4 level andBromage 3 scale respectively, as well as to regress to the T7 level and a Bromage1 scale were noted. Maternal nausea/vomiting or shivering, umbilical artery pH, and neonatal Apgar score at 1 and 5 min were also recorded. There were no differences between groups in systolic, diastolic blood pressure, heart rate (p=0.355, p=0.550, p=0.474 respectively), doses of phenylephrine or ephedrine, (p=0.920, p=0.142 respectively), time for the block to reach T4 (p=0.889) and Bromage scale 3(p=0.269), or to regress to T7 (p=0.273) and Bromage scale 1 (p=0.392), the incidence of nausea/vomiting (p=0.898/p=0.365), umbilical artery pH (p=0.739), neonatal Apgar score at 1 and 5 min (p=0.936 and p=0.907 respectively). Our results showed no significant effect of two different doses of ondansetron, in preventing maternal hypotension, following spinal anesthesia with ropivacaine for cesarean section.

Single intravenous dose ondansetron induces QT prolongation in adult emergency department patients: a prospective observational study

BackgroundOndansetron is one of the most commonly used drugs in the emergency department (ED) for treating nausea and vomiting, particularly in intravenous (IV) form. Nevertheless, it has been shown to prolong QT interval and increase the risk of ventricular dysrhythmias. This study evaluated the associations between single IV ondansetron dosage and subsequent QTc prolongation in the ED.MethodsIn this prospective observational study, a total number of 106 patients presenting to the ED in a 3-month period with nausea and vomiting treated with IV ondansetron were enrolled. QT and QTc intervals were measured at baseline (QT0 and QTc0), and 60 min (QT60 and QTc60) following a single-dose administration of ondansetron at 4 or 8 mg doses. To evaluate the predictive ability of these variables, we employed receiver operating characteristic (ROC) curve analyses.ResultsThe predictive models for QTc prolongation 1-hour post-ondansetron administration showed the following: at baseline, the area under curve of 0.70 for QT, 0.71 for QTc, and 0.64 for dosage. Conversely, a QTc0 = 375 msec indicated a QTc60 > 480 msec with a specificity of 97%. Additionally, a QTc0 of 400 msec had a sensitivity of 100% in predicting a QTc60 < 480 msec, while a QTc0 > 460 msec predicted a QTc60 > 480 msec with a specificity of 98%. Moreover, 8 mg doses were associated with higher rates of QTc60 prolongation, while 4 mg doses favored maintaining QTc60 within normal limits.ConclusionsOur study demonstrates the predictive capacity of QT0, QTc0, and ondansetron dosage in forecasting QTc60 prolongation (> 480 msec) post-ondansetron administration. These findings advocate for their incorporation into clinical protocols to enhance safety monitoring in adult ED patients.

Use of a Combination Lavender/Peppermint Aromatherapy Patch During Port Catheter Placement Under Monitored Anesthesia Care Does Not Reduce Time to Discharge Readiness: A Randomized Controlled Trial.

Background: Intraoperative anxiety is a common problem when Monitored Anesthesia Care (MAC) is used instead of general anesthesia during minor surgical procedures such as port catheter placement. Nonpharmacological anxiolytics such as aromatherapy have been studied for their effects on preoperative anxiety, but no placebo-controlled study of aromatherapy during surgeries under MAC has yet been performed. Methods: After IRB approval, 70 patients were randomized 1:1 to receive either a lavender/peppermint aromatherapy patch (Elequil Aromatabs®; Beekley Corporation) or a matching placebo patch. The primary outcome, time to readiness for discharge from postoperative acute care units (PACU; min), was assessed every 15 min until a modified postanesthesia recovery score for ambulatory patients (PARSAP) score of 18 or higher was reached. In the preoperative holding area, the assigned patch/placebo was activated and affixed to a folded towel placed aside the subject's head, contralateral to the side of the planned surgery. The towel and patch/placebo were discarded when the subject left the operating room (OR). Results: No difference was found between the treatment and placebo groups on the primary outcome of time to discharge readiness (mean [standard deviation, SD]: 82 [15] vs. 89 [21] min, respectively, p = 0.131). No difference was found between the treatment and placebo groups on the secondary outcomes of intraoperative midazolam dose, intraoperative opioid dose, intraoperative ondansetron dose, or intraoperative promethazine dose. No difference was found between the treatment and placebo groups in the proportion of subjects requiring rescue postoperative nausea and vomiting (PONV) medication in the PACU or the proportion of subjects requiring opioids in the PACU. No difference was found between the treatment and placebo groups in pain intensity in PACU, average PONV score in PACU, or patient satisfaction in PACU. PACU patient satisfaction was high for both the patch and placebo groups (35/35 [100%] vs. 32/34 [94%] "very satisfied," p = 0.239). Conclusions: Aromatherapy treatment is not indicated intraoperatively to reduce anxiety or the use of antiemetics in patients requiring Port catheter placement. Trial registration: Clinicaltrials.gov, identifier: NCT05328973.

Plasma Concentrations of Oral Ondansetron in Hospitalized Dogs Exhibiting Clinical Signs of Nausea.

The purpose of this study was to evaluate plasma ondansetron (OND) concentrations in a population of dogs with naturally occurring nausea after oral OND administration. Twenty-four dogs were randomly assigned to receive one of the following doses of oral OND: 0.5 mg/kg q8h, 0.5 mg/kg q12h, 1 mg/kg q8h, or 1 mg/kg q12h. Blood samples for plasma OND measurements were collected at baseline and 2, 4, and 8 h after administration of the first dose of OND. OND concentrations averaged over an 8 h time period were not significantly different between dose groups (0.5 mg/kg group: median 8.5 ng/mL [range 1-96.8 ng/mL], 1 mg/kg group: median 7.4 ng/mL [range 1-278.7 ng/mL]). The mean maximum concentrations in the 0.5 mg/kg and 1 mg/kg groups were 35.8 ± 49.0 ng/mL and 63.3 ± 121.1 ng/mL, respectively. OND concentrations were below the lower limit of quantification (LLOQ) in 50% (18/36) of samples in the 0.5 mg/kg groups and 39% (14/36) of samples in the 1 mg/kg groups. Six dogs (6/24, 25%) did not have OND detected at any time. The mean nausea scores at baseline were similar amongst all groups and decreased over time. The bioavailability of oral OND appears to be poor. Despite low plasma OND concentrations, nausea scores improved over time.

Effect of preoperative ondansetron on postoperative nausea in healthy dogs undergoing laparoscopic gastropexy and castration

ObjectiveTo investigate if preoperative ondansetron reduces postoperative nausea associated with laparoscopic gastropexy and castration in dogs. Study designProspective clinical study. AnimalsTwenty client-owned, healthy male dogs. MethodsDogs were premedicated with dexmedetomidine (2–5 mcg kg–1) and methadone (0.2–0.5 mg kg–1) intramuscularly. General anesthesia was induced with propofol and maintained with an inhalant anesthetic agent. Dogs were randomized into group S (saline 0.1 mL kg–1, intravenously) or group O (ondansetron 0.2 mg kg–1, intravenously). Plasma and serum were collected before premedication and 3 hours postextubation to measure arginine vasopressin (AVP) and cortisol concentrations. Nausea scoring occurred before and 10 minutes after premedication, immediately after extubation, and at 1, 2 and 3 hours postextubation. Data were analyzed by mixed and split-plot anova with Bonferroni adjustment for the number of group comparisons. Significance was set at p < 0.05. ResultsNausea scores increased over time at 1 (p = 0.01) and 2 (p < 0.001) hours postextubation in both groups compared with before premedication. Median nausea score (0–100 mm) for groups S and O before premedication were 2.5 and 0.5 mm, respectively. At 1 and 2 hours postextubation, group S scored 7.5 and 4.0 mm and group O scored 6.0 and 5.0 mm, respectively. No significant differences in nausea scores within or between groups were observed before premedication and 3 hours postextubation. Cortisol concentrations increased significantly 3 hours postextubation in both groups (p < 0.001) compared with before premedication, with no differences between groups. AVP concentrations showed no significant differences within or between groups. Conclusions and clinical relevancePreoperative intravenous administration of ondansetron (0.2 mg kg–1) did not impact postoperative nausea after laparoscopic gastropexy and castration. Investigation of higher doses of ondansetron on the incidence of postoperative nausea and vomiting in dogs after surgery is warranted.

Prospective evaluation of the emetogenic profile and analgesic efficacy of intravenous ibuprofen and metamizole in the immediate postoperative period of pediatric acute appendicitis.

Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce. We prospectively compared the analgesic and emetogenic profile of intravenous ibuprofen and metamizole in the immediate postoperative period of PAA. For this purpose, we used a sample of patients operated on in 2021 in our center. Participants were recruited on arrival at the Emergency Department and histopathological confirmation of the diagnosis was obtained in all of them. Pain was evaluated every 8 hours after the surgery with validated visual analog scales ranging from 0 to 10 points. Repeated measures ANOVA was used to compare the evolution of pain in the 48 hours after surgery between the two groups. The sample included 95 patients (65% males) with a mean age of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen (group 1) and 54 with metamizole (group 2). No significant differences were found in the level of pain either in the comparisons of point measurements or in its evolution in the 48 hours after surgery (p= 0.58). After adjusting for the received fluid therapy, children in the metamizole group had significantly more emetic episodes and needed significantly more doses of ondansetron. In our cohort, ibuprofen had a similar analgesic efficacy and a better emetogenic profile than metamizole in the immediate postoperative period of PAA. Future prospective, adequately controlled studies with larger sample sizes are needed to validate these findings.

Evaluation of palonosetron, fosaprepitant, and olanzapine as antiemetic prophylaxis for fludarabine and melphalan-based conditioning regimens prior to allogeneic hematopoietic stem cell transplants

BackgroundLimited data are available regarding efficacious antiemetic regimens to prevent chemotherapy-induced nausea and vomiting (CINV) for patients undergoing allogeneic hematopoietic stem cell transplant (HSCT). In patients aged 60 years or older, allogeneic HSCT is associated with improved survival, but tolerability of the transplant is a significant barrier. Fludarabine and melphalan (Flu–Mel) is a frequently utilized multi-day reduced intensity conditioning regimen for allogeneic HSCT. However, the optimal CINV prevention regimen is unknown. ObjectiveThe purpose of this study was to evaluate the efficacy of a novel CINV prophylaxis regimen prior to allogeneic HSCT with Flu–Mel compared to a historical control group. Study designThis was a retrospective, single-center, cohort review of 123 patients who received a Flu–Mel preparative regimen prior to allogeneic HSCT from January 1, 2019, to September 30, 2022. Fifty-nine patients received high dose ondansetron (HDO) for CINV prevention, while sixty-four patients received a combination of palonosetron, fosaprepitant, and olanzapine (PFO). The primary outcome was average number of rescue antiemetic doses administered per day. A key secondary outcome was time to first rescue antiemetic. ResultsThe median number of antiemetic doses used per day was significantly lower in patients who received PFO compared to HDO (1.94 doses [0.31–3.60] vs 3.31 doses [1.61–4.92]; p = 0.002). In addition, use of PFO significantly prolonged the median time to first rescue antiemetic compared to HDO (41.3 h [24.3–122.7] vs 26.2 h [14.7–48.1]; p = 0.016). ConclusionThe combination of palonosetron, fosaprepitant, and olanzapine is an effective antiemetic regimen for patients receiving a Flu–Mel-based preparative regimen.

Perioperative use of low dose haloperidol safely reduces episodes of postoperative nausea/vomiting and length of stay following elective minimally invasive bariatric surgery.

While total intravenous anesthesia (TIVA) protocols include Dexamethasone and Ondansetron prophylaxis, bariatric patients continue to be considered at particularly high risk for postoperative nausea/vomiting (PONV). A multimodal approach for prophylaxis is recommended by the Bariatric Enhanced Recovery After Surgery (ERAS) Society however, there remains a lack of consensus on the optimal strategy to manage PONV in these patients. Haloperidol has been shown at low doses to have a therapeutic effect in treatment of refractory nausea and in PONV prophylaxis in other high risk surgical populations. We sought to investigate its efficacy as a prophylactic medication for PONV in the bariatric population andto identify which perioperative strategies were most effective at reducing episodes of PONV. An institutional bariatric database was created by retrospectively reviewing patients undergoing elective minimally invasive bariatric procedures from 2018 to 2022. Demographic data reviewed included age, gender, preoperative body mass index (BMI), ethnicity, and primary language. Primary endpoints included patient reported episodes of PONV, total doses of Ondansetron administered, need for a second antiemetic (rescue medication), complication rate (most commonly readmission within 30days), and length of stay. Fisher's exact test, Mann-Whitney test, and ANOVA were used to evaluate the effect of perioperative management on various endpoints. A total of 475 patients were analyzed with Haloperidol being utilized in 15.8% of all patients. Patients receiving Haloperidol were less likely to require Ondansetron outside of the immediate perioperative period (34.7% vs. 49.8%, p = 0.02), experienced less PONV (41.3% vs. 64.3%, p = 0.01) and also had a decreased median length of stay (27.3 vs. 35.8h, p < 0.0001). Addition of low dose Haloperidol to Bariatric ERAS protocols decreases incidence of PONV and the need for additional antiemetic coverage resulting in a significantly shorter length of stay, increasing the likelihood of safe discharge on postoperative day 1.

Comparison Between Intravenous Weight-adjusted Ondansetron Dose and Dexmedetomidine in Preventing Shivering following Spinal Anaesthesia in Transurethral Resection of Prostate: A Randomized Controlled Study

Comparison Between Intravenous Weight-adjusted Ondansetron Dose and Dexmedetomidine in Preventing Shivering following Spinal Anaesthesia in Transurethral Resection of Prostate: A Randomized Controlled Study

Different Doses of Intravenous Ondansetron With Placebo on Attenuation of Spinal-induced Hypotension

Different Doses of Intravenous Ondansetron With Placebo on Attenuation of Spinal-induced Hypotension

Failure of two different doses of ondansetron to prevent maternal hypotension in spinal anesthesia with ropivacaine 0.75% for cesarean section; a randomized, double blind trial.

Introduction: Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, commonly used as an antiemetic has been proven in recent studies to be effective for the prevention of spinal-induced hypotension for elective cesarean section. &nbsp; Methods: One hundred and thirty-eight healthy primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Participants in the ONDA4, ONDA8, and CONTROL groups received 4 mg of ondansetron,&nbsp;8&nbsp;mg&nbsp;of ondansetron and&nbsp;normal saline respectively, 10 minutes before spinal anesthesia. Spinal anesthesia was performed at L3-L4 interspinous space, with 1.7 ml ropivacaine 0.75% and 15 mcg of fentanyl, via a 27 G pencil point needle. Blood pressure and heart rate were recorded upon arrival at the operating room, after preloading with 500 ml of 6% hydroxyethylstarch, at the time of spinal injection, and at one-minute intervals for 10 minutes thereafter. Blood pressure and heart rate values, total phenylephrine (mcg) or/and ephedrine (mg) doses, the incidence of maternal nausea/vomiting/shivering, umbilical artery pH and Apgar scores at 1 and 5 min were recorded. Time for the sensory block to reach T4 and regress to T7 dermatome, and the time for the motor block to reach Bromage scale 3 and to regress to Bromage scale 1, were also noted. &nbsp; &nbsp; Results: There were no differences between groups in hemodynamic parameters or doses of vasoactive agents used, sensory or motor block characteristics, incidence of nausea/vomiting, umbilical artery pH or Apgar scores of the neonates. &nbsp; Conclusion: Our results failed to demonstrate the significance of ondansetron in preventing maternal hypotension following spinal anesthesia for cesarian section.

Ondansetron Safety Regarding Prolong QTc for Children with Head Trauma

BackgroundThere have been recent reports of increased QT interval after head trauma in concussed athletes and adult patients. Ondansetron, which is widely used in treatment of nausea and vomiting symptoms in head injuries, was issued a safety warning from the U.S. Food and Drug Administration regarding QT prolongation and risk of fatal dysrhythmias. ObjectiveThe purpose of this study was to evaluate the safety of ondansetron regarding QT prolongation for patients experiencing nausea or vomiting after head trauma. MethodsPatients aged 1–20 years presenting to a pediatric emergency department with head trauma and who required a dose of ondansetron for nausea or vomiting were enrolled in the study. Patients received a baseline 12-lead electrocardiogram (ECG) prior to administration of either oral or IV ondansetron. A second post-ondansetron 12-lead ECG was performed after administration of ondansetron. All ECGs were reviewed and the QTc calculated manually by a board-certified pediatric cardiologist. ResultsForty-two patients met enrollment criteria. Five patients received IV ondansetron and 37 received oral ondansetron. Mean QTc pre ondansetron was 387.5 ms and mean QTc post ondansetron was 400.9 ms (p = 0.120). We found no statistically significant difference in other ECG parameters pre and post ondansetron. ConclusionsOndansetron is safe in regard to QTc prolongation in patients with head trauma. Based on this research, ondansetron should continue to be used for the treatment of nausea and vomiting in emergency department patients who present with head injury.

Effectiveness of Ondansetron in comparison to Domperidone for treating vomiting in acute gastroenteritis among children in a tertiary care hospital setting: A quasi-experimental study

BACKGROUND &amp; OBJECTIVE: There is inconsistent evidence on using antiemetic drugs (ondansetron and domperidone) in children with vomiting associated with gastroenteritis having dehydration. The study's objective was to compare the effectiveness of oral domperidone with ondansetron for treating vomiting during acute gastroenteritis in children with either mild or moderate dehydration.&#x0D; METHODOLOGY: This non-controlled quasi-experimental study was conducted at Allama Iqbal Teaching Hospital, Sialkot, in the department of Pediatrics from 1st October 2019 to 31st December 2019. Sixty children aged 1-12 years having acute gastroenteritis, with mild or moderate dehydration after the failure of initial oral rehydration therapy, were included. Children in-group A (n=30) received a single dose of an orally disintegrating tablet of ondansetron, and children in-group B (n=30) were treated with domperidone. The absence of vomiting for 6 hours and subsequent successful rehydration in these two groups was the primary outcome. The Chi-square test was applied to compare the frequency of primary outcome between the ondansetron and domperidone groups, considering p-value ≤0.05 was considered statistically significant.&#x0D; RESULTS: The mean age of patients was 4.4±1.8 years in group A compared to 5.1±2.7 years in group B. Oral Ondansetron was successful in controlling vomiting in 19(63.4%) patients compared to 11(36.6%) in domperidone group (p=0.39).&#x0D; CONCLUSION: The single dose of oral ondansetron compared to domperidone was significantly effective in controlling the vomiting in-patient with acute gastroenteritis presented with either mild or moderate dehydration, resulting in effective oral rehydration subsequently.

IS LOW DOSE KETAMINE EFFECTIVE AS ANTIEMETIC PROPHYLAXIS FOR INTRAOPERATIVE NAUSEA AND VOMITING DURING CAESAREAN SECTION UNDER SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMIZED STUDY

Background: Intra-operative nausea and vomiting (IONV), which occurs in around 40- 60% of the patients undergoing CS under regional anaesthesia, is an uncomfortable feeling for patients, upsets obstetricians, distresses anaesthetists and may increases the risk of visceral injury during surgery because of the involuntary uncontrolled abdominal movements. Hypotension can induce the emetic symptoms by leading to cerebral hypo perfusion. Ketamine has unique central sympathomimetic, vagolytic and analgesic properties. These properties of ketamine are assumed to reduce the incidence of spinal induced hypotension and consequently nausea and vomiting. Material and methods: 120 patients posted for caesarean section under spinal anaesthesia were enrolled for the study after clearance from institutional ethical committee. Patients of group I - received low dose IV ketamine in dose of 0.5 mg/kg in 5ml Normal Saline Group II - received IV ondansetron in dose of 4 mg in 5ml Normal Saline Group III - Received IV 5ml Normal Saline, slow IV over 5 mins. Incidence of nausea, vomiting and complete response, hemodynamic, sedation score and block characteristics were noted at xed intervals. Results: group I (ketamine) had maximum percentage of complete response (82.5 %). The difference in complete response among the three groups was statistically signicant (p value – 0.001), whereas incidence of nausea and vomiting among the three group was comparable (p value – 0.021, 0.037). Apgar score noted was of grade 9 with statistically insignicant difference among all the groups (p- value 0.52). Conclusion: patients undergoing elective caesarian section under spinal anaesthesia who have high risk of IONV; prophylactic therapy of low dose ketamine (0.5 mg/kg) just before giving spinal anaesthesia can be used for prevention of IONV without any adverse effect on neonates similar to IV ondansetron.

Embryo-fetal safety evaluation of ondansetron in rats.

Ondansetron is a 5HT3 receptor antagonist, used to mitigate the effects of nausea and vomiting after chemotherapy or surgery. Since nausea and vomiting are common experiences during the first trimester of pregnancy, this antiemetic has been the main drug used during this period. To evaluate the effects of ondansetron on the embryo-fetal development, which are still very contradictory, pregnant rats were exposed to therapeutic doses of ondansetron (1.7 or 2.5 mg/kg) daily, from gestational day (GD) 6 to 15. No clinical signs of toxicity were observed in dams during the treatment. Although the hemato-biochemical parameters were similar among the groups, histological changes, as well as a reduction in the weight of kidney were found in the treated dams. After fetal examination, no visceral and skeletal abnormalities were observed in treated fetuses. In conclusion, therapeutic doses of ondansetron have low teratogenic potential in rats. These data provide important information about the drug safety during pregnancy.

670 DEXMEDETOMIDINE SEDATION FOR PULMONARY VEIN ISOLATION PROCEDURE

Abstract Background Peri-procedural anesthesia for catheter ablation of atrial fibrillation (AF) varies from conscious sedation to general anesthesia. Current guidelines do not suggest any specific strategy, thus the choice between different protocols is mainly driven by local expertise, operator and/or patient preference and availability of a dedicated anesthesiology team. Propofol is often the drug of choice despite the risk of respiratory depression. Few data have recently reported operator-directed nurse-administered dexmedetomidine (DEX) sedation as an effective and safe strategy. Aim of the study To evaluate the outcomes of operator-directed nurse-administered DEX sedation in AF ablation (pulmonary vein isolation-PVI). Method Between May 2022 and August 2022, 41 consecutive patients (male 83%, median age 64 years, IQR 57-71) with drug-refractory paroxysmal (n.27;66%) or persistent AF (n.14;34%) underwent first PVI procedure under DEX sedation. Our sedation protocol consisted of continuous intravenous administration of DEX (0.2–0,7 µg/kg/hr) titrated throughout the procedure to achieve mild to moderate sedation (Modified Observer's Assessment of Alertness and Sedation Scale 2-3). A single dose of Ondansetron (4 mg) was administered in the beginning of procedure. Adjunctive doses of fentanyl (cumulative dose 50-100 µg) were administered before the beginning of radiofrequency (RF) delivery and in case of inadequate control of the pain. A low dose propofol bolus (&amp;lt;1mg/kg) was eventually added for electrical cardioversion (ECV). Sedation-related complications were evaluated, including sustained hypoxemia (SpO2 &amp;lt;90%), need of anesthesiologist support and persistent hypotension (SBP &amp;lt; 90 mmHg). The day after the procedure, patients’ satisfaction and pain (0-100 scale) were assessed by a standardized questionnaire. Results Pulmonary vein isolation was performed either with Low Power Long Duration (LPLD, n.17;41,46%) or High-Power Short Duration (HPSD, n.24;58,54%) RF protocol. Median procedure time was 135’ (IQR 110-170’). Median DEX dose was 0,30 µg/kg/hr (IQR 0,27-0,33 µg/kg/hr). Median fentanyl dose was 75 µg (IQR 50-100 µg). In patients needing for ECV (n. 16; 39%), median propofol dose was 60 mg (IQR 47,5–105 mg). Thirteen patients (31,7%) had one or more significant risk factor (obesity, severe heart failure, pulmonary comorbidity, coronary artery disease) for anesthesia-related complications. Median pain scale value was 20 (IQR 10-50). Majority of patients (90,2%, n.37) reported mild to moderate pain (pain &amp;lt;60/100) during the procedure and satisfaction was overall high (median value 90, IQR 80-100), with a 90,2% of patients declaring a satisfaction of 60/100 or more. These results were independent from baseline characteristics (sex, age, AF type, HF, CAD, pulmonary comorbidity, obesity) and procedural aspects (LPLD vs HPSD, procedure time, need for ECV). A strong linear correlation was found between patients’ satisfaction and reported pain (r=-0,59). Only 1 (2,4%) sedation-related complication occurred, consisting in sustained post procedural hypotension treated with volume repletion. Conclusions in our experience, dexmedetomidine (DEX) sedation protocol during catheter ablation of atrial fibrillation is associated to high patients’ satisfaction and no respiratory complications. It seems to be also feasible in patients at higher risk for anesthesia-related complications (severe heart failure, BMI &amp;gt; 30 kg/m2), generally excluded from previous studies.