Originally presented by Dr Jason Sritharan

Background

  • Bezold-Jarish Reflex (BJR): bradycardia, vasodilation, hypotension
    • Chemoreceptors are an important trigger for BJR during hypovolaemic conditions
    • Ondansetron inhibits BJR, proposed to decrease incidence of post-spinal hypotension
  • Administration of 4-8mg of IV ondansetron pre-spinal for LSCS is routine practice at certain institutions

The data

  • 2 RCTs demonstrated a reduced incidence of intraoperative hypotension & ephedrine consumption with IV ondansetron
  • Cochrane review: ondansetron administration more effective than saline for preventing hypotension requiring treatment (low quality evidence)
  • No statistically significant difference between 4mg or 8mg IV ondansetron

Conclusion

  • There is some evidence to suggest that administration of ondansetron pre-spinal reduces the incidence of hypotension for elective LSCS

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