THE EFFECT OF GRANISETRON

AND ONDANSETRON ON
HEMODYNAMIC DURING
CAESAREAN SECTION UNDER
SPINAL ANESTHESIA

Ahmad Nur Islam 1*, Alamsyah A.A.2, Muh. Ramli Ahmad2,

Syafruddin Gaus2, Hisbullah2

1. Resident and 2. Staff Departement of Anesthesiology, Intensive

Care and Pain Management
Hasanuddin University, Faculty of Medicine, Makassar, Indonesia
INTRODUCTION

 The use of regional anaesthesia in Caesarean

section (Cs) has increased a lot in last few
decades1
 Spinal Anesthesia (SA) : the most popular
anesthesia technique for Cs
 SA in Cs  hypotension and bradycardia2
 The incidence of hypotension has been estimated
to be as high as 50–60%.
 Hypotension compromises placental circulation
and can have a detrimental effect on the foetus
dangerous

1. Heesen. Anesth Analg 2016;123:977–88)

2. Sahoo. Int J Obstet Anesth. 2012 Jan;21(1):24-8
  SA : sympatholysis  ↓ SVR  ↓ Venous
Return  triggering cardiac receptor in
cardiac wall  vasodilation, bradycardia,
hypotension
 The BJR : explain perioperative hypotension
associated with bradycardia
 The BJR  5HT3 receptors on vagus nerve
and within the wall of the ventricles binding
of serotonin to the 5HT3 receptor  activates
the BJRbradycardia and hypotension
 5-HT3 antagonists receptor: block the Bezold-
Jarisch reflex in animal models in human
studies  potential to prevent spinal
anesthesia-induced hypotension
1. David C. Warltier,Jason A. Campagna,Christopher Carter. Anesthesiology 2003;98:1250-60
2. Heesen. Anesth Analg 2016;123:977–88
 • Heesen et al (2016): 5-HT3 receptor
antagonist were effective in reducing the
incidence of hypotension and bradycardia1
5-HT3 • Sahoo (2011): preloading 20 ml/kg
Receptor crystaloid for 30 min and premedicatin 4
Antagoni mg Ondansetron i.v 5 min before SAB  
st hypotension & vasopressor use in mothers
Research undergoing cesarean section2
es • Mahmoud and Shaaban (2017): 4 mg
Ondansetron, 1 mg Granisetron 5 min
before SAB effectively decreased the
incidence of hypotension, nausea and
vomiting3

1. Heesen. Anesth Analg 2016;123:977–88)

2. Sahoo. Int J Obstet Anesth. 2012 Jan;21(1):24-8
3. Alaa El Deen M, Ahmed S. Euro J Pharm Med Res 2017;4(6): 758-65
 5-HT3 Receptor Antagonist
• Carbazalon derivatives ,specific,
potent, selective, & affinity-sensitive
5-HT1 receptor antagonist properties
with 5-HT1B, 5-HT1C, 5-HT4
receptor, opioid, & adrenergic
receptors.1
• Effective when given orally or i.v
Ondansentr
• 4-8 mg Ondansetron IV> 2-5 min
on
immediately before induction of
anesthesia is very effective  PONV
incidence in vulnerable patient
populations.2
• Oral 0.15 mg / kg Ondansetron p.o or
0.05-0.15 mg /kg Ondansetron i.v
effective  postoperative vomiting.

1. Dasgupta M, Biswas BN, Chattarjee S, Mazumder P, Bhaja CM. J Obstet Gynaecol India 2012;62(4):419-23.
2. Owczuk R, Wenski W, Polak-Krzeminska A, Twardowksi P, Renata M, Anna DS, Magdalena AW, et al.. Reg Anesth Pain Med
2008;33:332-9
 5-HT3 Receptor Antagonist

• 5-HT3 receptor antagonists: more

selective than ondansetron.
• Low affinity or not binding to other
serotonin receptors.
Granisetron • Effectively orally and IV.
• Low doses of 0.02-0.04 mg / kg / i.v
are effective in the prevention of
emesis due to chemotherapy &
PONV prevention.

1. Aapro M. Oncologist 2004;9:673-86.

Research Theory Flowchart
OBJECTIVE

The aim of our study was to evaluate the effect

5-hydroxytryptamine 3 (5-HT3) receptor
antagonists between Granisetron and
Ondansetron on hemodynamic in parturients
undergoing Cs with spinal anesthesia
METHODS
Inclusion Criteria: Exclusion criteria
1. Agree to participate 1. Refused to
in research participate
2. Age 20-45 yo 2. Contraindications to
3. BMI < 30 kg/m2 spinal anesthesia
4. BH: > 150 cm 3. Patients with a
history of hypertension
5. ASA PS II
and cardiovascular
6. Elective surgery disease
7. There is consent 4. History of
from the primary care hypersensitivity to
physician local anesthetic agent
Research Method Flowchart
 • The obtained data is processed &
the result is displayed in the form of
Data Analysis narration, table or graphic of average
& standard deviation, frequency
using SPSS 25 for Windows

• Data: expressed as number and

mean±SD for quantitative variables.
• Categorical variables: analyzed using
Statistical Chi-squared test or Fisher’s exact test.
Analysis • Numerical variables normally
distributed between groups: Student’s
independent samples t-test p<0.05
was statistically significant
Result

 The sample size of 40 people is divided into: 20

samples of Group O and 20 samples of Group
G.
 No significant differences were observed in
patients demographic (age, BMI, and ASA PS)
between the two groups (p>0.05)


 There was no difference of HR changes

between the two groups (p>0.05)
 Table 1. Demographic details and side
effect by each group
Group G Group O p value
(n=20) (n=20)
Age (years) † 28.95±4.45 28.55±6.32 0.818
BMI (kg/m2) † 25.38±2.24 25.88±2.74 0.532
ASA PS‡ 20 (100) 20 (100) 1.000
Nausea/Vomiti 0(20) 5(20) 0.047*
ng §
Vasopressor 0 0 -
Use §
Data presented in number of patient (n) or mean±SD. .*:p<0.05, analyzed with Fisher’s exact test.
†: analyzed with Student’s independent samples t-test, ‡: analyzed with Chi-square test. § :
analyzed with Fisher’s exact test.
Figure 1. Comparison MABP (mmHg) Changes in
group G and group O
Figure 2. Comparison HR (bpm) changes in
group G and group O
DISCUSSION
 Our findings is consistent with study by
Mahmoud and Shaaban in 2017 :
prophylactic intravenous 4 mg Ondansetron
or 1 mg Granisetron compared to saline as
placebo significantly reduced the severity of
hypotension induced by spinal anesthesia.1
 Present study, prophylactic 0.03 mg/kg
Granisetron and 0.1 mg/kg Ondansetron 30
min before spinal anesthesia no difference
in hemodynamic changes no incidence
vasopressor use in each group.

1. Alaa El Deen M, Ahmed S. Euro J Pharm Med Res 2017;4(6): 758-65

2. Aapro M. Oncologist 2004;9:673-86
  Our study  Dose of drug according to body weight
and given 30 minutes before spinal anesthesia 
drug onset2
 Ondansetron and Granisetron, although both of them
from the same category and have same mechanism
of action, may be due to the action of Ondansetron
on mixed receptors and the high selectivity of
Granisetron on 5-HT3 receptors
 Ondansetron and Granisetron prevented the
serotonin-induced BJR, suppressed venodilatation,
augmented venous return to the heart and resu lted
in lesser reductions in MABP
1. Aapro M. Granisetron: an update on its clinical use in the management of nausea and vomiting. Oncologist. 2004;9:673–86.
2. Alaa El Deen M, Ahmed S. Euro J Pharm Med Res 2017;4(6): 758-65
Conclusion

Granisetron and Ondansetron has similar effect on

preventing hemodynamic changes during Cs under spinal
anesthesia
Thank You