Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section

Abhishek Chatterjee, Bhanu Gudiwada, Pratap Rudra Mahanty, Himanshu Kumar, Deb Sanjay Nag, Pradip Kumar Ganguly, Rajiv Shukla, Abhishek Chatterjee, Bhanu Gudiwada, Pratap Rudra Mahanty, Himanshu Kumar, Deb Sanjay Nag, Pradip Kumar Ganguly, Rajiv Shukla

Abstract

Background and aim: Spinal anesthesia is the most common type of anesthesia administered for caesarean section and it is frequently associated with hypotension. When post-spinal hypotension is accompanied with bradycardia, the condition may become more complicated. Numerous pharmacological agents have therefore been tried for prevention of hypotension and 5HT3 antagonists are the latest in the armamentarium. However, studies have shown conflicting evidence regardings the effectiveness of 5HT3 inhibitors (ondansetron and granisetron) in preventing spinal hypotension. We have tried to address this controversy and also wanted to explore the adverse effects of granisetron on the foetus, if any.

Materials and methods: Two hundred patients were included in the study and divided into two groups of 100 patients each. Group S patients received 5ml of 0.9% normal saline while Group G patients received IV granisetron 1mg (diluted to 5ml) 10 minutes prior to administration of spinal anesthesia. Analysis of variance (ANOVA) test was used for comparing the data, Student t-test was applied to compare the difference between the two means and Chi-Square test was used to test significance of difference of proportions.

Results: The incidence of hypotension in Group S was 69%, whereas it was 37% in Group G (p<0.001), hence patients of Group S required a significantly higher (p=0.001) amount of mephentermine. Haemodynamic parameters were well maintained throughout the study period in patients of Group G. The neonatal outcome was assessed by Apgar score at 0 minutes, one minute, and five minutes after delivery, and it was comparable between the two study groups.

Conclusion: Intravenous granisetron 1mg if administered before administering spinal anesthesia can effectively attenuate hypotension in parturients without any adverse effects on the mother and the neonate.

Keywords: caesarean section; granisetron; hypotension; spinal anesthesia.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Chatterjee et al.

Figures

Figure 1. Trend of systolic blood pressure…
Figure 1. Trend of systolic blood pressure in the two groups
Figure 2. Trend of diastolic blood pressure…
Figure 2. Trend of diastolic blood pressure in the two groups
Figure 3. Trend of mean arterial blood…
Figure 3. Trend of mean arterial blood pressure in two groups

References

    1. Maternal and anaesthesia-related risk factors and incidence of spinal anaesthesia-induced hypotension in elective caesarean section: a multinomial logistic regression. Fakherpour A, Ghaem H, Fattahi Z, Zaree S. Indian J Anaesth. 2018;62:36–46.
    1. Incidence and risk factors for side effects of spinal anesthesia. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Anesthesiology. 1992;76:906–916.
    1. Maternal haemodynamic changes during caesarean section: a comparison of epidural and general anaesthesia. Milsom I, Forssman L, Biber B, Dottori O, Rydgren B, Sivertsson R. . Acta Anaesthesiol Scand. 1985;29:161–167.
    1. Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice. Burns SM, Cowan CM, Wilkes RG. . Anaesthesia. 2001;56:794–798.
    1. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Gunusen I, Karaman S, Ertugrul V, Firat V. Anaesth Intensive Care. 2010;38:647–653.
    1. Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution. Riley ET, Cohen SE, Rubenstein AJ, Flanagan B. Anesth Analg. 1995;81:838–842.
    1. Hemodynamic effects of intravenous isoproterenol versus epinephrine in the chronic maternal-fetal sheep preparation. Marcus MA, Vertommen JD, Van Aken H, Wouters PF. Anesth Analg. 1996;82:1023–1026.
    1. Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section. Ramanathan S, Grant GJ. Acta Anaesthesiol Scand. 1988;32:559–565.
    1. Westfall TC, Westfall DP. Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 12e. New York: McGraw-Hill Education; 2006. Adrenergic agonists and antagonists.
    1. Current issues in spinal anesthesia. Liu SS, McDonald SB. Anesthesiology. 2001;94:888–906.
    1. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Martinek RM. Can J Anaesth. 2004;51:226–230.
    1. Platelet activation in carotid sinuses triggers reflex sympathoinhibition and hypotension. Mao HZ, Li Z, Chapleau MW. Hypertension. 1996;27:584–590.
    1. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Owczuk R, Wenski W, Polak-Krzeminska A, et al. . Reg Anesth Pain Med. 2008;33:332–339.
    1. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Sahoo T, Sen Dasgupta C, Goswami A, Hazra A. Int J Obstet Anest. 2012;21:24–28.
    1. A comparative study of prophylactic intravenous granisetron, ondansetron, and ephedrine in attenuating hypotension and its effect on motor and sensory block in elective cesarean section under spinal anesthesia. Khalifa OS. Ain-Shams J Anaest. 2015;8:166–172.
    1. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: a double-blind, prospective randomized controlled study. Eldaba AA, Amr YM. J Anaesthesiol Clin Pharmacol. 2015;31:329–332.
    1. Efficacy of granisetron on attenuation of hemodynamic responses of parturients undergoing elective cesarean delivery under spinal anesthesia. Mohammadi SS, Mehrpoor S, Saliminia A. Arc Anest Crit Care. 2017;3:373–377.
    1. Clinical comparative study of the effects of intravenous ondansetron and granisetron on hemodynamic changes, shivering, and motor & sensory blockade induced by spinal anesthesia in women undergoing cesarean section. Megahed MA, Hady AM, Sayed AE, Mohamed MA. NY Sci J. 2017;10:7–16.
    1. Use of granisetron for prevention of hypotension and bradycardia due to spinal anesthesia: a double blind randomised control trial. Shrestha BK, Acharya SP, Marhatta MN. JSAN. 2015;1:36–39.
    1. Effect of granisetron in attenuation of hypotension following spinal anaesthesia in parturients undergoing elective caesarean section-a double blind randomized controlled trial. Lamichhane S, Koirala S, Singh SN. JSAN. 2016;3:13–17.
    1. Investigating the effect of granisetron on the prevention of hypotension after spinal anesthesia in cesarean section. Behdad S, Saberi V, Saberi H. Journal of Basic and Clinical Medicine. 2016;5:22–25.
    1. Die afferenten Bahnen des Veratrineffektes in den Herznerven (Article in German) Jarisch A, Richter H. Naunyn Schmiedebergs Arch Exp Pathol Pharmakol. 1939;193:355–371.
    1. Ondansetron versus granisetron - effects on hemodynamic instability during spinal anesthesia for caesarean section. Sayed AE, Mohamed AS. Eur J Pharm Med Res. 2017;4:758–765.
    1. Level of sensory block after spinal anesthesia as a predictor of hypotension in parturient. Zhang N, He L, Ni JX. Medicine (Balt) 2017;96:0.
    1. Manitshana N. Johanesberg: 2016. Occurrence and Duration of Spinal-Induced Hypotension in Caesarean Section Patients at an Academic Hospital.
    1. The Apgar score. American Academy of Pediatrics; Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists; Committee on Obstetric Practice. Adv Neonatal Care. 2006;6:220–223.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren