Chatterjee Abhishek, Gudiwada Bhanu, Mahanty Pratap Rudra, Kumar Himanshu, Nag Deb Sanjay, Ganguly Pradip Kumar, Shukla Rajiv
Anaesthesiology, Tata Main Hospital, Jamshedpur, IND.
Anaesthesiology, Varma Hospital, Bhimavaram, IND.
Cureus. 2020 Dec 16;12(12):e12113. doi: 10.7759/cureus.12113.
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.
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.
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.
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.
脊髓麻醉是剖宫产最常用的麻醉方式，且常伴有低血压。当脊髓麻醉后低血压伴有心动过缓时，情况可能会变得更复杂。因此，人们尝试了多种药物来预防低血压，5-羟色胺3（5HT3）拮抗剂是最新加入的药物。然而，关于5HT3抑制剂（昂丹司琼和格拉司琼）预防脊髓麻醉后低血压效果的研究结果相互矛盾。我们试图解决这一争议，并探讨格拉司琼对胎儿是否有不良影响。
本研究纳入200例患者，分为两组，每组100例。S组患者在脊髓麻醉前10分钟静脉注射5ml 0.9%生理盐水，G组患者在脊髓麻醉前10分钟静脉注射1mg格拉司琼（稀释至5ml）。采用方差分析（ANOVA）检验比较数据，采用学生t检验比较两组均值差异，采用卡方检验检验比例差异的显著性。
S组低血压发生率为69%，而G组为37%（p<0.001），因此S组患者所需的美芬丁胺量显著更高（p=0.001）。在整个研究期间，G组患者的血流动力学参数保持良好。通过分娩后0分钟、1分钟和5分钟的阿氏评分评估新生儿结局，两组研究结果具有可比性。
脊髓麻醉前静脉注射1mg格拉司琼可有效减轻产妇低血压，且对母亲和新生儿均无不良影响。
