Qin Rui, Xu Xiangzhao, Zhao Na, Shi Yongqiang, Chen Yi, Chen Jinhua, Ni Xinli
Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Department of Anesthesiology, The People's Hospital of Nanchuan, Chongqing, China.
Front Med (Lausanne). 2025 Apr 3;12:1495721. doi: 10.3389/fmed.2025.1495721. eCollection 2025.
BACKGROUND: 5-hydroxytryptamine 3 (5-HT3) receptor antagonists have been reported to reduce post-spinal anesthesia hypotension, though their efficacy remains controversial. We investigated the effect of prophylactic ondansetron on hemodynamic stability in patients undergoing cesarean section following spinal anesthesia. METHODS: Patients scheduled for elective cesarean section ( = 120) were randomly allocated to three groups (NS group, 4 mg group, 8 mg group) of 40: those given 4 mL of normal saline (NS), and those given either 4 mg or 8 mg ondansetron (4 mL) before spinal anesthesia. Patient information, maternal systolic blood pressure stability [median performance error (MDPE), median absolute performance error (MDAPE)], the incidence of post-spinal anesthesia hypotension, norepinephrine doses, other adverse events (severe post-spinal anesthesia hypotension, nausea, vomiting, bradycardia, and hypertension), umbilical artery blood gas values, and infant Apgar scores were all recorded. RESULTS: The primary outcomes (median performance error, MDPE and median absolute performance error, MDAPE) were significantly different among the three groups. ( = 0.001, = 0.002). Compared with the NS group, systolic blood pressure (SBP) was maintained closer to baseline in the 4 mg group ( = 0.003, = 0.006), as was the 8 mg group ( = 0.011, = 0.006). There was a significant difference in the incidence of post-spinal anesthesia hypotension among the three groups ( = 0.002). However, only there was a statistical difference between NS and the 8 mg groups in pairwise comparisons ( = 0.001). The doses of norepinephrine, the incidences of other adverse events, umbilical artery blood gas, and Apgar scores were not statistically different between the three groups. CONCLUSION: Prophylactic 4 mg or 8 mg ondansetron improved hemodynamic stability after spinal anesthesia in cesarean section; however, only 8 mg reduced post-spinal anesthesia hypotension. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT05475873.
背景：据报道，5-羟色胺3（5-HT3）受体拮抗剂可降低脊麻后低血压，但其疗效仍存在争议。我们研究了预防性使用昂丹司琼对脊麻后剖宫产患者血流动力学稳定性的影响。 方法：计划行择期剖宫产的患者（n = 120）被随机分为三组（生理盐水组、4mg组、8mg组），每组40例：分别给予4ml生理盐水（NS），以及在脊麻前给予4mg或8mg昂丹司琼（4ml）。记录患者信息、产妇收缩压稳定性[中位性能误差（MDPE）、中位绝对性能误差（MDAPE）]、脊麻后低血压发生率、去甲肾上腺素剂量、其他不良事件（严重脊麻后低血压、恶心、呕吐、心动过缓和高血压）、脐动脉血气值和婴儿阿氏评分。 结果：三组的主要结局（中位性能误差，MDPE和中位绝对性能误差，MDAPE）有显著差异（F = 0.001，P = 0.002）。与生理盐水组相比，4mg组（P = 0.003，P = 0.006）和8mg组（P = 0.011，P = 0.006）的收缩压（SBP）维持在更接近基线的水平。三组脊麻后低血压发生率有显著差异（F = 0.002）。然而，在两两比较中，仅生理盐水组和8mg组之间存在统计学差异（P = 0.001）。三组之间去甲肾上腺素剂量、其他不良事件发生率、脐动脉血气和阿氏评分无统计学差异。 结论：预防性使用4mg或8mg昂丹司琼可改善剖宫产脊麻后的血流动力学稳定性；然而，只有8mg可降低脊麻后低血压。 临床试验注册：Clinicaltrials.gov，NCT05475873。
Pharmaceuticals (Basel). 2022-12-19
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