Bradycardia, Hypotension, Hypotension During Surgery, Spinal Anesthesia Induced Hemodynamic Change
Conditions
Keywords
ondansetron, spinal anesthesia, geriatric patients, hemodynamic instability, urologic surgery
Brief summary
Spinal anesthesia is frequently used in urologic surgery in geriatric patients; however, it may cause significant hemodynamic changes such as hypotension and bradycardia. These changes can be more pronounced in elderly patients due to age-related physiological alterations. Ondansetron, a 5-HT3 receptor antagonist commonly used for the prevention of postoperative nausea and vomiting, has been suggested to attenuate spinal anesthesia-induced hemodynamic instability by modulating vagal reflexes. This prospective observational study aimed to evaluate the effects of ondansetron on hemodynamic changes following spinal anesthesia in geriatric patients undergoing urologic surgery. Hemodynamic parameters were recorded during the intraoperative period, and the incidence of hypotension, bradycardia, and vasopressor requirements were assessed.
Detailed description
This study was designed as a prospective observational study conducted in geriatric patients undergoing urologic surgery under spinal anesthesia. Patient enrollment and data collection were performed prospectively between December 18, 2024, and April 18, 2025. The study protocol was approved by the TABED Ethics Committee (Approval No: 1-24-840, December 18, 2024). Ondansetron was administered according to routine clinical practice. Hemodynamic parameters, including mean arterial pressure and heart rate, were recorded at predefined time points following spinal anesthesia. The incidence of spinal anesthesia-induced hypotension, bradycardia, and the need for vasopressor support were evaluated. Although patient enrollment and data collection were conducted prospectively, the study was registered retrospectively at ClinicalTrials.gov due to delayed trial registration.
Interventions
None listed
Sponsors
Ankara City Hospital Bilkent
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 65 years and older Patients scheduled for elective urologic surgery under spinal anesthesia American Society of Anesthesiologists (ASA) physical status I-III Patients who received routine perioperative management, with or without ondansetron administration Patients who provided written informed consent
Exclusion criteria
* Refusal or contraindication to spinal anesthesia Known hypersensitivity or contraindication to ondansetron Preexisting severe cardiac conduction abnormalities (e.g., high-grade atrioventricular block, sick sinus syndrome) Baseline bradycardia (heart rate \< 50 beats per minute) Chronic use of medications significantly affecting heart rate or blood pressure (e.g., beta-blockers, calcium channel blockers, antiarrhythmic drugs) Emergency surgery Incomplete perioperative hemodynamic data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Spinal Anesthesia-Induced Hypotension | rom induction of spinal anesthesia until the end of surgery | The occurrence of spinal anesthesia-induced hypotension, defined as a decrease in mean arterial pressure of 20% or more from baseline during the intraoperative period. |
| Incidence of Spinal Anesthesia-Induced Bradycardia | From induction of spinal anesthesia until the end of surgery | The occurrence of spinal anesthesia-induced bradycardia, defined as a decrease in heart rate of 20% or more from baseline during the intraoperative period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ephedrine Requirement | From induction of spinal anesthesia until the end of surgery | The need for intraoperative ephedrine administration to treat hypotension following spinal anesthesia. |
| Atropine Requirement | From induction of spinal anesthesia until the end of surgery | The need for intraoperative atropine administration to treat bradycardia following spinal anesthesia. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORZeynep Nur Akçaboy, MD
Department of Anesthesiology, Ankara City Hospital
Outcome results
None listed