Prophylactic Ondansetron Administration to Attentuate Spinal Anesthesia-Induced Hypotension in Cesarean Section

Abstract

Purpose: This quality improvement (QI) project aims to evaluate the impact of the educationprovided to anesthesia providers on the prophylactic use of ondansetron to attenuate spinal anesthesia-induced hypotension (SAIH) in cesarean section. Knowledge acquisition and the intent to change practice will be measured to determine the impact. Background: Spinal anesthesia is a preferred technique in managing obstetric patients having cesarean section because it allows practitioners to avoid the potential complications associated with general anesthesia. Despite several proposed therapies, SAIH remains a prevalent adverse effect that manifests shortly after spinal block. The hypotension generated by spinal anesthesia is a result of suppression of the sympathetic nervous system (sympathectomy) and activation of the Bezold-Jarisch Reflex (BJR). The BJR activation exacerbates hypotension and can lead to asystole and cardiovascular collapse. Studies have shown that 5-hydroxytryptamine subtype 3 (5- HT3) receptor antagonists can effectively reduce BJR activation. Ondansetron is a 5-HT3 receptor antagonist linked to a reduction in the frequency and severity of SAIH. Methods: A presentation of an educational session to improve anesthesia providers' knowledge to promote the timely use of prophylactic ondansetron as an adjunct therapy to attenuate SAIH incidence in cesarean section. The impact outcomes of this educational session will be the measurement of the percentage of anesthesia providers reporting an improved knowledge and favorable intention towards incorporating the usage of timely prophylactic ondansetron in cesarean section in their daily care. Results: As only 40% of participants provided timely prophylactic ondansetron, as an adjunct, five minutes before to spinal block to prevent SAIH in cesarean section, a pre-intervention 11 survey revealed the necessity for an educational session on the matter. The percentage grew to 100% after the presentation. Participants' knowledge enhancement and retention of almost 100% of the presentation showed in the 30-day post-interventional survey are directly correlated with the participant's willingness to continue to administer prophylactic ondansetron in a timely manner to attenuate SAIH in cesarean section. Conclusions: Following the educational presentation, anesthesia providers improved their knowledge and intention to use timely ondansetron as an adjunct therapy for attenuating SAIH incidents in cesarean section.