الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Many anesthetists prefer spinal anesthesia for women who will undergo cesarean section. regional anaesthesia is associated with reduced maternal mortality, faster neonatal-maternal bonding, decreased blood loss and excellent postoperative pain control. Spinal induced hypotension represents incidence of about 70-80%, so it is the most frequent complication.
Moreover, hypotension is hazardous for both the mother and the baby as it can cause loss of consciousness, aspiration, and even cardiac arrest for the mother and placental hypoperfusion, which can lead to fetal problems. There are several methods to minimize maternal hypotension after spinal anesthesia like fluids, medications, and physical methods. Preloading is commonly administered but it has controversial results.
The aim of this work was to compare and determine the effectiveness of prophylactic intravenous ondansetron and granisetron in ameliorating hypotension following spinal anaesthesia in parturients undergoing CS.
The present study was carried out at El-Shatby Obstetrics & Gynecology Hospital, University of Alexandria, on 60 parturients, aged 20-40 years old, ASAI-II, scheduled for elective caesarean section under spinal anaesthesia, after the approval from the Local Ethical Committee and informed consents from all the patients of the study.
Parturients were randomly divided into three equal groups (20 parturients each); group O (ondansetron group), group G (granisetron group) and group C (control group).
An intravenous access using 18-gauge cannula was inserted in the non-dominant hand of all parturients. Each patient received 15-20 ml/kg lactated Ringer’s solution before spinal anaesthesia. Patients were randomly allocated into three groups (group O) received 4 mg of IV ondansetron diluted in 10 mL of normal saline, (group G) received IV granisteron 1mg diluted in 10 ml of normal saline and (group C) normal saline 10 ml was given over 2 min 5 min before spinal anaesthesia. The spinal technique performed with the patient in the sitting position at L3-4 or L4-5. Hyperbaric bupivacaine 0.5% (5mg/ml) 7.5 – 12.5 mg (according to height of the patient) were administered intrathecally through a 25 G Quincke`s spinal needle. Supplemental oxygen (5 L/min) was administered by a simple face mask during the operation.
Hypotension is defined as a decrease in MAP to more than or equal 20% of baseline and bradycardia is defined as less than 60 beats per minute. Hypotension was treated with increments of 6 mg of ephedrine IV, bradycardia with 0.4 mg of atropine IV.
Hemodynamic measurements (heart rate, mean arterial blood pressure, oxygen saturation), total dose of ephedrine and atropine, upper sensory level, time of delivery of fetus, incidence of nausea and vomiting, incidence of shivering all were recorded and statistically analyzed.
The present study found that ondansetron and granisetron produced significantly higher MAP than the placebo group in the period from 5 min (78.90±9.39 mmHg, 78.30±7.36 mmHg vs. 68.30±8.63 mmHg respectively, p=0.001) to 25 minutes (78.0±3.95 mmHg, 76.70±6.63 mmHg vs. 72.75±8.53 mmHg respectively, p= 0.041). After 30 minutes, there was no significant difference until the last measure post operatively at 180 minutes. While HR was revealed statistically significant higher in ondansetron and granisetron groups than control group in the period from 5 minutes (102.25±13.86, 97.85±17.98 vs. 84.90±22.34 respectively, P=0.012) to 15 minutes (98.15±14, 96.25±17.25 vs. 83.30±18.26 respectively, P=0.012) of intra-operative time .
Comparison between the three studied groups showed statistical significant increase in total dose of ephedrine in group C than group O and G at all the measured times (p = 0.001). Number of parturients who did not require ephedrine supplements were significantly more, in group O and G about 12 parturients while in group C about 4. Also the control group was the more and frequent significantly users of atropine doses.
Comparison between the three studied groups as regard oxygen saturation showed insignificant differences at all the measured times.
There were statistical significant decrease in nausea and vomiting in group O and G than group C (p = 0.001). With Median value of 1 in group O and G, while in group C a median was 3.
Comparison between the three studied groups as regard complication showed statistical insignificant differences.
There were statistical insignificant differences between the studied groups as regard duration of surgery and Apgar score.
The present study concluded that the tow drugs ondansetron and granisetron was successfully attenuated spinal induced hypotension and bradycardia in parturients undergoing CS and reduce the amount of vasopressors use, also the two drugs decrease the incidence of nausea and vomiting significantly.