Date of Award

2018

Degree Name

Management Practice in Nurse Anesthesia

College

Graduate College

Type of Degree

DMPNA

Document Type

Research Paper

First Advisor

Dr. Alberto Coustasse, Committee Chair

Second Advisor

Dr. Nancy Tierney, Committee Member

Abstract

Introduction: Neuraxial (spinal) anesthesia is a favored modality in the care of obstetric patients undergoing a cesarean-section (C-section). Spinal anesthesia is additionally popular as an alternative method for various surgical procedures in non-obstetric patients allowing practitioners to avoid potential risks associated with the use of general anesthesia. Spinal anesthesia-induced hypotension (SAIH) is a common side effect that presents status post-initiation of spinal anesthesia. The source of the hypotension produced after the initiation of spinal anesthesia is due to inhibition of the sympathetic nervous system (sympathectomy) and bradycardia caused by stimulation of the Bezold-Jarisch Reflex. A relatively new intervention that practitioners are using to mitigate the stimulation of the Bezold-Jarisch Reflex is the use of 5-HT3 receptor antagonists. Ondansetron is a 5-HT3 receptor antagonist implicated in decreasing the incidence and severity of SAIH.

Objective: The purpose of this literature review was to examine the efficacy of the prophylactic administration of ondansetron (5-HT3 receptor antagonist) before induction of spinal anesthesia in the attenuation of the incidence of SAIH. The hypothesis used in this research study was : Does Prophylactic Administration Of Ondansetron Prior To Spinal Anesthesia Decrease Spinal-Anesthesia Induced Hypotension In Obstetric And Non-Obstetric Patients”:

Methodology: The current literature review attempts to identify recent studies on the use of prophylactic ondansetron before spinal anesthesia and its ability to decrease the incidence of SAIH. Databases which included: PUB-MED, Academic Search Premier, EBSCO Host, and Google-Scholar were searched for randomized control trials (RCTs) investigating the effects of ondansetron and its ability to attenuate SAIH. The principal outcome of the focus for this review was the incidence of hypotension after the initiation of spinal anesthesia. PRISMA guidelines and the Cochrane Risk of Bias Tool influenced the design and data collection of this review.

Results: Eleven studies (Five non-obstetric and six obstetric) consisting of 1,257 patients (non-obstetric n = 616, Obstetric n = 641) categorized by the American Society of Anesthesiology (ASA) class I-III were included in this review. Three out of five non-obstetric-group studies support the hypothesis of this literature review and concluded that prophylactic ondansetron administered before spinal anesthesia was effective in decreasing the incidence of hypotension compared to a placebo. Three out of six obstetric group studies also supported the hypothesis of this literature review and concluded that prophylactic ondansetron before spinal anesthesia was effective in decreasing the incidence of hypotension when compared to a placebo.

Discussion/Conclusion: The results of this literature review show that the prophylactic administration of ondansetron before induction of spinal-anesthesia does not clearly inhibit stimulation of the BJR or significantly decrease the incidence of SAIH in obstetric and non-obstetric patients. Additional studies are needed focusing on uniformity in testing so there can be stronger correlations in comparing results, and thus more definitive conclusions can be made.

Subject(s)

Anesthesia -- Research.

Anesthesiology -- Research.

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