Effect of Palonosetron in the Prevention of Spinal Anaesthesia-induced Hypotension and Bradycardia: A Randomised Controlled Trial
Introduction: Spinal Anaesthesia (SA) is frequently associated with hypotension, which is due to sympathectomy causing vasodilation, leading to relative hypovolemia. This decrease in venous return to the heart causes a decrease in left ventricular filling pressure, leading to the activation of t...
Main Authors: | , , , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2023-09-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://www.jcdr.net/articles/PDF/18399/64867_CE[Ra1]_F(IS)_QC(KK_SL)_PF1(RI_KM)_PFA_NC(RI_KM)_PN(KM).pdf |
Summary: | Introduction: Spinal Anaesthesia (SA) is frequently associated
with hypotension, which is due to sympathectomy causing
vasodilation, leading to relative hypovolemia. This decrease in
venous return to the heart causes a decrease in left ventricular
filling pressure, leading to the activation of the Bezold-Jarisch
Reflex (BJR), which causes bradycardia. This response is
mediated by mechanoreceptors and chemoreceptors present
on the heart walls. These chemoreceptors are mediated through
serotonin (5-HT). Therefore, the activation of 5-HT3 receptors at
sensory vagal nerve endings in the heart causes hypotension
and bradycardia.
Aim: To assess the efficacy of Palonosetron in attenuating spinal
anaesthesia-induced hypotension and bradycardia.
Materials and Methods: The trial was a parallel-design,
randomised, double-blind controlled trial conducted over two
years, from February 2021 to August 2022 in the Department of
Anaesthesiology, Kalinga Institution of Medical Sciences (KIMS),
Bhubaneswar, Odisha, India, among patients undergoing spinal
anaesthesia for various surgeries. The patients were divided into
two groups based on the type of medication received: Group APalonosetron group and Group B- the saline group. Computergenerated random number generator software was used for
randomisation. At a 1:1 ratio, 150 patients were chosen (75 in
each group). Baseline assessment of haemodynamic parameters
was performed, followed by continuous monitoring. The drug
was administered 10 minutes prior to spinal anaesthesia, and
the haemodynamic parameters (Heart Rate [HR], Systolic Blood
Pressure [SBP], Diastolic Blood Pressure [DBP], and Mean
Arterial Pressure [MAP]) were monitored. Continuous variables
are expressed as mean±Standard Deviation (SD). The Student’s
t-test was used to compare the difference between the two
groups, and categorical variables are expressed as frequency
and percentage, with comparisons done using the Chi-square
test. A p-value of <0.05 was considered statistically significant.
Results: The mean age of Group A and Group B was 40.88
and 42.14, respectively. Significant haemodynamic changes
(hypotension) were observed following induction in Group B
(28 [37.3%]) compared to Group A (9 [12%]). Consumption of
vasopressors and intravenous (i.v.) fluids was significantly higher
in Group B compared to Group A. The incidence of bradycardia in
Group A and Group B was 15 (20%) and 18 (24%), respectively.
Postoperative Nausea and Vomiting (PONV) in Group A and
Group B were 3 (4%) and 8 (10.7%), respectively.
Conclusion: Based on the present study, the prophylactic
administration of 0.075 mg Palonosetron 10 minutes before
subarachnoid block is effective in attenuating the incidence
of spinal anaesthesia-induced hypotension and bradycardia.
There is also decreased consumption of vasopressors and a
lower incidence of PONV.. |
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ISSN: | 2249-782X 0973-709X |