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Title: Comparison of effect of prophylactic administration of ondansetron and placebo on prevention of post induction hypotension in elderly patients undergoing surgery in general anesthesia
Authors: Lala Rukh Bangash, Aqsa Akhter, Madiha Zafar, Arsalan Zaki, Marium Waheed, Anum Anwar
Journal: Journal of Fatima Jinnah Medical University (JFJMU)
Publisher: Fatima Jinnah Medical University, Lahore
Country: Pakistan
Year: 2022
Volume: 16
Issue: 2
Language: English
DOI: 10.37018/AALR.8618
Keywords: EfficacyOndansetronHypotension
Background: Post-induction hypotension is a frequently encountered complication seen particularly in elderly population. Hypotension, by impairing vital organ perfusion, increases the morbidity and mortality of the patients. prophylactic use of ondansetron in preventing hypotension after induction of general anaesthesia in elderly patients , hence getting the benefit of preventing both hypotension and postoperative nausea and vomiting by the use of a single drug.
Subjects and method: This randomized controlled clinical trial was carried out in the operation theaters of general surgery, Mayo Hospital, Lahore, from 09-09-2017 to 09-09-2018. A total of 80 patients who were to undergo general anaesthesia for elective general surgical procedures were recruited for this study. After taking informed consent, the patients were randomly divided into two groups. Patients in group A received ondansetron and those in group B received placebo prior to the induction of anaesthesia. Efficacy was labeled in terms of absence of hypotension i.e. a drop in mean arterial pressure of no more than 25% of baseline at 1, 3, 5, 9 and 11 minutes after induction of anaesthesia. The data was recorded on a predesigned proforma. Statistical analysis was done using SPSS version 21.
Results: Both groups were comparable in terms of age, gender, ASA status, BMI and weight. Efficacy was seen in 19 (47.50%) cases managed by ondansetron vs. 10 (25%) in placebo group (p = 0.03). There was significant difference of efficacy in patients with age between 60 to 70 years where 63.63% patients in the Group A effectively maintained their blood pressure (p=0.02). Patients having age 70 years or above did not show statistically significant difference. History of hypertension made no impact on the efficacy of ondansetron for maintaining blood pressure after induction (p=0.53)
Keywords:                
      Ondansetron, Efficacy, Hypotension
To determine the efficacy of prophylactic use of ondansetron in preventing hypotension after induction of general anaesthesia in elderly patients aged 60 years and above.
Randomized controlled clinical trial conducted in operation theaters. 80 elderly patients (60 years and above) undergoing elective general surgical procedures under general anesthesia were recruited. Patients were randomly divided into two groups: Group A received ondansetron, and Group B received placebo prior to anesthesia induction. Efficacy was measured by the absence of hypotension (a drop in mean arterial pressure of no more than 25% of baseline) at specific time points after induction. Data was analyzed using SPSS version 21.
graph TD
A["Recruit 80 elderly patients 60+"] --> B["Randomly assign to Group A"Ondansetron" or Group B"Placebo""];
B --> C["Administer Ondansetron/Placebo pre-induction"];
C --> D["Induce general anesthesia"];
D --> E["Monitor Mean Arterial Pressure MAP at 1, 3, 5, 9, 11 mins"];
E --> F["Assess efficacy: <25% MAP drop from baseline?"];
F -- Yes --> G["Patient maintained blood pressure"];
F -- No --> H["Patient experienced hypotension"];
H --> I["Administer ephedrine if needed"];
G --> J["Record data"];
H --> J;
J --> K["Analyze data using SPSS v21"];
K --> L["Draw conclusions"];
The study suggests that prophylactic ondansetron may help prevent post-induction hypotension in elderly patients, particularly those in the 60-70 age group. While ondansetron is known to blunt the hypotensive effect of spinal anesthesia, its exact mechanism in preventing hypotension during general anesthesia requires further investigation. The study used a 4mg dose of ondansetron, which is standard for PONV prophylaxis, and suggests further research into higher doses for hypotension prevention.
Ondansetron group showed efficacy in 47.5% of cases compared to 25% in the placebo group (p = 0.03). In patients aged 60 to 70 years, 63.63% in the ondansetron group maintained blood pressure, showing a significant difference (p=0.02). No statistically significant difference was observed in patients aged 70 years or above. History of hypertension did not impact the efficacy of ondansetron.
Prophylactic use of ondansetron may prevent post-induction hypotension in patients aged 60 to 70 years undergoing elective surgery under general anesthesia.
1. A total of 80 patients were recruited for the study. (Confirmed in "Subjects and method" section).
2. Efficacy was seen in 47.5% of cases managed by ondansetron versus 25% in the placebo group. (Confirmed in "Results" section).
3. The study was carried out from 09-09-2017 to 09-09-2018. (Confirmed in "Subjects and method" section).
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