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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