Archives of Anesthesiology and Critical Care 2017. 3(4):373-377.

Efficacy of Granisetron on Attenuation of Hemodynamic Responses of Parturients Undergoing Elective Cesarean Delivery under Spinal Anesthesia
Sussan Soltani Mohammadi, Somayeh Mehrpoor, Alireza Saliminia


Background: Maternal bradycardia and hypotension are the most common intraoperative complications after spinal anesthesia during cesarean delivery. Prophylactic administration of ondansetron has been reported to provide a protective effect. In this study we evaluated the effect of intravenous granisetron, another serotonin 5-HT3 receptor antagonist, on prevention of these complications.

Methods: Thirty-four ASA class I-II patients undergoing elective cesarean section under spinal anesthesia were randomly allocated into two equal groups, control saline (n=17) or granisetron groups (n=17). After insertion of standard monitorings,5ml/kg lactated Ringer’s solution was infused over 15 minutes. In saline group 3ml of 0.9% saline and in granisetrone 3mg (3ml) granisetron was injected intravenously five minutes before spinal anesthesia. Systolic and diastolic blood pressure and heart rate were all recorded every two minutes during first twenty minutes and then every five minutes until the end of surgery and compared between the groups.

Results: Demographic data and median of sensory block level were not statistically different between the groups. There was no statistical difference between the study groups regarding the systolic, diastolic and heart rate at measured points except at second minutes after spinal anesthesia that was lower in saline group (P=0.01).

Conclusion: This study showed that intravenous granisetron has little protective effect on attenuation of hemodynamic responses of parturients undergoing elective cesarean section under spinal anesthesia.


cesarean section; granisetron; hemodynamic response; spinal anesthesia

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Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001; 94(5):888–906.

Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76(6):906–16.

Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg. 2010; 111(5): 1230-7.

Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006; (4):CD002251.

Aviado DM, Guevara Aviado D. The Bezold-Jarisch reflex: a historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci. 2001; 940:48–58.

Campagna JA, Cartner C. Clinical relevance of Bezold Jarisch reflex. Anesthesiology. 2003; 98(5):1250-60.

Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: A double-blind randomised, placebo-controlled study. Int J Obstet Anesth. 2012; 21(1): 24-8.

Wang Q, Zhuo L, Shen MK, Yu YY, Yu JJ, Wang M. Ondansetron Preloading with Crystalloid Infusion Reduces Maternal Hypotension during Cesarean Delivery. Am J Perinatol. 2014; 31(10): 913-22.

Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszułowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med. 2008; 33(4):332-9.

Ortiz-Gómez JR, Palacio-Abizanda FJ, Morillas-Ramirez F, Fornet-Ruiz I, Lorenzo-Jiménez A, Bermejo-Albares ML. The effect of intravenous ondansetron on maternal hemodynamics during elective caesarean delivery under spinal anaesthesia: a double-blind, randomised, placebo-controlled trial. Int J Obstet Anesth. 2014; 23(2):138-43.

Marashi SM, Soltani-Omid S, Mohammadi SS, Aghajani Y, Movafegh A. Comparing two different doses of intravenous ondansetron with placebo on attenuation of spinal-induced hypotension and shivering. Anesth Pain Med. 2014; 4(2):e12055.

Khalifa OS. 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. Ain-Shams J Anesthesiol. 2015; 8(2):166-172.

Abbas N, Shah SAR, Naqvi SS. Role of prophylactic ondansetron for prevention of spinal anesthesia induced hypotension in lower segment cesarean section. Pak Armed Forces Med J 2016; 66(6):790-94.

Tubog TD, Kane, TD, Pugh MA. Effects of Ondansetron on Attenuating Spinal Anesthesia–Induced Hypotension and Bradycardia in Obstetric and Nonobstetric Subjects: A Systematic Review and Meta-Analysis. AANA Journal; 2017: 85(2):113-122.

Yeoh SB, Leong SB, Heng AST. Anaesthesia for lower-segment caesarean section. Indian J Anaesth. 2010; 54(5): 409–14.

Agarwal A, Kishore K. Complications and Controversies of Regional Anaesthesia : A Review. Indian J Anaesth. 2009; 53(5): 543-53.

Tamilselvan P, Fernando R, Bray J, Sodhi M, Columb M. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial. Anesth Analg. 2009; 109(6): 1916-21.

Gunusen I, Karaman S, Ertugrul V, Firat V. 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. Anaesth Intensive Care. 2010; 38(4): 647-53.

Chohedri AB, Khojeste L, Shahbazi S, Alahyari E. Ephedrine for prevention hypotension; comparison between intravenous,intramuscular and oral administration during spinal anesthesia for elective Cesarean section. Professional Med J. 2007; 14(4): 610-5.


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