Prophylactic Use Of Ondansetron Research Articles

Prophylactic Use of Ondansetron for Hypotension Prevention in Cases Undergoing Cesarean Section Post-Spinal Anesthesia

Background: Ondansetron is being administrated to prevent post spinal hypotension and its affects are promising. Globally, researches being conducted to identify the prophylactic effects of ondansetron. Aim: To determine the frequency of maternal hypotension with or without intravenous administration of ondansetron in cases undergoing cesarean section post-spinal anesthesia. Study design: Randomized controlled trial Place and duration of study: Jinnah Postgraduate Medical Centre, Karachi from 1st February 2017 to 1st August 2017. Methodology: Eighty four pregnant females between 18-35 years of age enrolled for cesarean-section under spinal anesthesia were included. Patients having a history of cardiorespiratory or renal disorders, as well as bradycardia or tachycardia, hypo/hypertension and or hyperglycemia were excluded. The patients were randomly divided into Group A (ondansetron) and Group B (control) by using codes placed in sealed, sequentially numbered envelopes. The mean value of arterial blood pressure and of the heart rate was documented at 3 min interval for 10 minutes and then every 5 minutes till 30 minutes after spinal anesthesia. Results: The mean age of patients in group A was 26.57±5.28 years and in group B was 26.88±4.62 years. Thirty two (38.10%) were ASA I and 52 (61.90%) were ASA II. The mean age of patients in group A was 39.36±1.65 weeks and in group B was 39.79±1.47 weeks. Mean arterial pressure was 138.44±13.59mmHg. Frequency of maternal hypotension in Group A was seen in 08 (19.05%) while in Group B was seen in 22 (52.38%) patients (p=0.001). Conclusion: There is less maternal hypotension with intravenous administration of ondansetron in patients undergoing cesarean section under spinal anesthesia. Keywords: Spinal anesthesia, Hypotension, Ondansetrone

Comparison of effect of prophylactic administration of ondansetron and placebo on prevention of post induction hypotension in elderly patients undergoing surgery in general anesthesia

Background: Post-induction hypotension is a frequently encountered complication seen particularly in elderly population. Hypotension, by impairing vital organ perfusion, increases the morbidity and mortality of the patients. prophylactic use of ondansetron in preventing hypotension after induction of general anaesthesia in elderly patients , hence getting the benefit of preventing both hypotension and postoperative nausea and vomiting by the use of a single drug.
 Subjects and method: This randomized controlled clinical trial was carried out in the operation theaters of general surgery, Mayo Hospital, Lahore, from 09-09-2017 to 09-09-2018. A total of 80 patients who were to undergo general anaesthesia for elective general surgical procedures were recruited for this study. After taking informed consent, the patients were randomly divided into two groups. Patients in group A received ondansetron and those in group B received placebo prior to the induction of anaesthesia. Efficacy was labeled in terms of absence of hypotension i.e. a drop in mean arterial pressure of no more than 25% of baseline at 1, 3, 5, 9 and 11 minutes after induction of anaesthesia. The data was recorded on a predesigned proforma. Statistical analysis was done using SPSS version 21.
 Results: Both groups were comparable in terms of age, gender, ASA status, BMI and weight. Efficacy was seen in 19 (47.50%) cases managed by ondansetron vs. 10 (25%) in placebo group (p = 0.03). There was significant difference of efficacy in patients with age between 60 to 70 years where 63.63% patients in the Group A effectively maintained their blood pressure (p=0.02). Patients having age 70 years or above did not show statistically significant difference. History of hypertension made no impact on the efficacy of ondansetron for maintaining blood pressure after induction (p=0.53)
 Keywords: 
 Ondansetron, Efficacy, Hypotension

A Comparative Study of Efficacy and Safety of Ondansetron, Glycopyrrolate and Dexamethasone for Post Operative Nausea and Vomiting Following General Aneasthesia

Postoperative nausea and vomiting (PONV) is a common distressing problem in patients undergoing surgery under general anaesthesia which requires frequent medical interventions. This was a prospective, randomized study conducted in Victoria hospital, Bengaluru. Study subjects were randomly assigned into four groups of twenty patients in each. Group A received inj. Ondansetron 8 mg i.v, Group B received inj Glycopyrrolate 0.2 mg i.v, Group C received inj Dexamethasone 10 mg i.v and Group D received 1ml normal saline i.v, just before induction of anaesthesia with inj fentanyl and inj propofol. Number of patients having nausea & vomiting was assessed for 24 hrs after surgery. Out of eighty patients 47 (58.7%) patients had nausea and vomiting in the postoperative period. Six (30%) patients in group A, eleven (55%) in group B, thirteen (65%) in group C and seventeen (85%) patients in group D. Use of rescue antiemetic was higher in normal saline group followed by dexamethasone group. Headache was reported as an adverse effect in less than 10% of the patients. Our study showed that prophylactic use of ondansetron is more effective for prevention of PONV with lesser requirement of rescue medication and fewer side effects, followed by glycopyrrolate and dexamethasone.

Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study.

Background:Spinal anesthesia is a safe anesthetic technique commonly practiced. However, it is associated with hypotension (33%), bradycardia (13%), and shivering which are induced by hypovolemia, sympathetic blockade, and Bezold–Jarisch reflex through intracardiac serotonin (5HT3) receptors and vagus nerve.Aim:To study the effect of intravenous (i.v.) ondansetron on hypotension and bradycardia induced by spinal anesthesia.Setting and Design:This was a randomized controlled double-blinded study done in a tertiary care teaching hospital.Methods:Of 140 patients, 70 in Group A received 2 mL of i.v. ondansetron 4 mg and 70 in the Group B received 2 mL of i.v. normal saline. 3 mL of 0.5% hyperbaric bupivacaine was injected intrathecally. Measurements of blood pressure and heart rate (HR) were taken every 3 min for 30 min after spinal anesthesia was performed. Mean arterial pressure (MAP) drop more than 20% was considered as incidence of hypotension and ephedrine 6 mg i.v. was given. HR drop >20% was regarded as bradycardia and atropine 0.5 mg i.v. was given.Statistical Tests:Quantitative data were analyzed using ANOVA test and qualitative data were analyzed using Chi-square test.Results:Both groups are comparable in demographic data. Four (5.7%) patients in Group B and no patients in Group A had incidence of bradycardia and atropine requirement (P = 0.120). There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, and MAP. 19 (27%) patients in Group A and 33 (47.1%) in Group B required ephedrine with P = 0.029. 12 (17.1%) in Group B and no patients in Group A had shivering with P = 0.0001.Conclusion:Our study indicates that prophylactic use of ondansetron before spinal anesthesia significantly reduces the requirement of ephedrine and shivering.

Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron

Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. In this randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I and II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software. The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions. Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.

Prophylactic use of intravenous ondansetron versus ketamine - midazolam combination for prevention of shivering during spinal anesthesia: A randomized double-blind placebo-controlled trial.

Background:The aim of this study was to compare the efficacy intravenous (IV) ondansetron with ketamine plus midazolam for the prevention of shivering during spinal anesthesia (SA).Materials and Methods:Ninety patients, aged 18–65 years, undergoing lower extremity orthopedic surgery were included in the present study. SA was performed in all patients with hyperbaric bupivacaine 15 mg. The patients were randomly allocated to receive normal saline (Group C), ondansetron 8 mg IV (Group O) or ketamine 0.25 mg/kg IV plus midazolam 37.5 μg/kg IV (Group KM) immediately after SA. During surgery, shivering scores were recorded at 5 min intervals. The operating room temperature was maintained at 24°C.Results:The incidences of shivering were 18 (60%) in Group C, 6 (20%) in Group KM and 8 (26.6%) in Group O. The difference between Groups O and Group KM with Group C was statistically significant (P < 0.05). No significant difference was noted between Groups KM with Group O in this regard (P > 0.05). Peripheral and core temperature changes throughout surgery were not significantly different among three groups (P > 0.05). Incidence (%) of hallucination was not significantly different between the three groups (0, 3.3, 0 in Group O, Group KM, Group C respectively, P > 0.05).Conclusion:Prophylactic use of ondansetron 8 mg IV was comparable to ketamine 0.25 mg/kg IV plus midazolam 37.5 μg/kg IV in preventing shivering during SA.

Comparison of Ondansetron and Metoclopramide for PONV Prophylaxis in Laparoscopic Cholecystectomy

Background: Postoperative nausea and vomiting (PONV) are common distressing complications of surgery and anaesthesia. Objective: The present study was designed to compare the relative antiemetic efficacy and safety of intravenous (I/V) ondansetron and metoclopramide for prevention of PONV after elective laparoscopic cholecystectomy in adult female patients under General Anesthesia (GA). Material and methods: In this prospective, randomized, placebo-controlled, double-blind study we included 150 adult American Society of Anesthesiologists (ASA) Grade I or II female patients, aged 18-55 years, undergoing elective laparoscopic cholecystectomy under GA. The anaesthetic technique, drugs, monitoring and care were standardized in all the patients during the perioperative period. The patients were divided into two groups using random numbers table. Group A (n=50) received ondansetron 4 mg/2ml while group B (n=50) received metoclopramide 10 mg/2 ml I/V just before induction of anaesthesia. Patients were observed for the initial 24 hours after anesthesia. The presence or absence of nausea and vomiting (by simply yes or no) was assessed by a resident anesthetist double blind to the study The rescue antiemetic (cyclizine 10 mg) I/V, was given, if patient suffered from nausea for more than 15 minutes, or experience retching or vomiting during study period. Results: In comparison to metoclopramide group, the frequency of nausea and vomiting was clinically and statistically lower in ordansetron group (p=0.035). Use of rescue antiemetic was significantly higher in metoclopramide group (p=0.022). Conclusion: Our study showed that prophylactic use of ondansetron is more effective with fewer side effects than metoclopramide in the prevention of PONV during laparoscopic cholecystectomy in adult females. Furthermore, metoclopramide was associated with more adverse effects, major being dizziness and extrapyramidal symptoms.

Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study

Pruritus is the most common side effect of intrathecal morphine for postoperative pain relief. Activation of central 5-hydroxytryptamine subtype 3 (5-HT3) receptors is one of its possible mechanisms. The role of 5-HT3 antagonists in the prevention of pruritus has not been clearly established. In a prospective, randomized, double-blind, placebo-controlled study, we evaluated the efficacy of prophylactic administration of ondansetron and dolasetron for the prevention of intrathecal morphine-induced pruritus. The patients were randomized into 3 groups to receive either 4 mg ondansetron IV (group O, n = 35), 12.5 mg dolasetron IV (group D, n = 35) or 5 mL placebo (group P, n = 35) 30 min before administration of spinal anesthesia with 10 to 17.5 mg of 0.5% hyperbaric bupivacaine and 0.25 mg of morphine for urologic, orthopedic, or vascular surgery. Patients were evaluated for incidence and severity of pruritus at arrival to the postanesthesia care unit and at 2, 4, 8, and 24 h postoperatively. The incidence and severity of pruritus was significantly less frequent in the ondansetron and dolasetron groups compared with placebo (34%, 20%, and 66% respectively, P < 0.01). Patients who received 5-HT3 antagonist reported significantly less total severity of pruritus compared with placebo during the first 8 h and the severe pruritus was observed only in patients within P group (P group: 4 of 35; 11%, O or D group: 0 of 35; 0%, P < 0.05). We conclude that the prophylactic use of ondansetron and dolasetron helps to reduce the incidence and severity of intrathecal morphine-induced pruritus.

Cost-effectiveness analysis of antiemetic therapy for ambulatory surgery

To compare the relative cost-effectiveness ratios of (1) therapy with ondansetron, droperidol, and metoclopramide in the prevention of postoperative nausea and vomiting (PONV), and (2) prophylactic versus rescue therapy of PONV with these agents. Cost-effectiveness analysis based on the estimated costs of 12 mutually exclusive outcomes identified by decision analysis. Computer model of outcome established using data extracted from published studies and a survey of current practice in two university-affiliated hospitals. Patients undergoing operations associated with a high risk of PONV. The cost-effectiveness of prophylactic antiemetic therapy was compared among three drugs and also compared with limiting treatment to established PONV. Direct costs included drug acquisition, drug delivery, equipment used in managing vomiting, and additional nursing time costs. Indirect costs included drugs and materials used to treat persistent nausea and/or vomiting and the side effects of prophylactic drugs, increased time spent in the postanesthesia care unit, unanticipated hospitalization, and lost earnings due to hospitalization. Separate models were created for patients with both nausea and vomiting and with isolated nausea. The total incremental costs associated with the prophylactic use of ondansetron, metoclopramide, and droperidol were $37.74, $28.43, and $18.17 per patient, respectively. The costs per emesis-free patient with the prophylactic use of ondansetron, metoclopramide, and droperidol, were $55.91, $71.08, and $30.15, respectively, and per nausea-free patient $68.93, $82.74, and $33.52, respectively. Prophylactic antiemetic therapy was cost-effective for operations with a high frequency of emesis, whereas treatment of established symptoms was more cost-effective when the frequency was lower. For ondansetron, prophylactic use was cost-effective only when the frequency of emesis exceeded 33%, whereas prophylactic droperidol was cost-effective even if the frequency was 10%. When drug costs, efficacy, and adverse events were all considered, prophylactic droperidol was more cost-effective than ondansetron, and both drugs were more cost-effective than metoclopramide. However, the expected frequency of PONV, as well as local drug acquisition costs, can significantly influence whether a particular antiemetic is cost-effective when given prophylactically or only as therapy for established PONV.

Amonafide as first-line chemotherapy for metastatic breast cancer

In a phase II study, 32 patients with advanced breast cancer previously unexposed to palliative cytotoxic chemotherapy were treated with amonafide, 800–900 mg intravenously over 3 h repeated every 4 weeks. Objective response was seen in 8 patients including 1 complete response, 10 patients had stable disease and 14 patients progressed so the overall response was 25% (95% confidence interval, 11–43%). The most frequently encountered side-effects were haematological (granulocytopenia ⩾ WHO grade 3 was encountered in 7 24 patients at 800 mg/m 2 and in 3 8 patients at 900 mg/m 2 amonafide) and nausea/vomiting (62%), despite prophylactic use of ondansetron. Non-haematological severe adverse reactions included neurotoxicity WHO grade 3 in 1 patient and orthostatic hypotension WHO grade 4 in another. In summary, the results of this trial suggest a limited therapeutic index of amonofide if used at this dose with this administration schedule.