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Spinal anesthesia is the preferred route of anesthesia for parturients undergoing casesarean section (Hawkins et al., 2011). Parturients with obesity undergo caesarean delivery and have higher rates of initial intrathecal failure comparatively to non-obese (Hood, et al, 2015). Obesity is on the rise leading to a reconsideration as to the dosing of spinal anesthetic type (Dennis, 2017). Historically, the utilization of ondansetron, as a selective 5-HT3 antagonist, has been utilized prior to spinal administration to prevent the sympathectomy that can occur (Sahoo et al., 2012). This has decreased the utilization of vasopressors which can be detrimental to the fetus during cesarean (Kinsella et al., 2017).
A literature search was performed using major databases. 30 articles experimental studies, randomized control trials (RCT) and systematic reviews of RCTs with or without meta-analysis published within the last ten years were selected for initial review. 17 articles were identified as related to obesity and pregnancy undergoing spinal anesthesia for cesarean section.
Ondansetron’s utilization as an effective attenuator of a subarachnoid block sympathectomy has been accepted through various studies. However, through the literature review, a gap in obesity with dosing of prophylactic 5-HT3 antagonists and intrathecal local anesthetics, as well as, objective non-invasive data collecting to facilitate spinal anesthetic hypotension from occurring.
Lind, Peter O., "Effectiveness Of Ondansetron Prior To Spinal Anesthesia In Obese Parturients Undergoing Caesarean Delivery" (2023). Nurse Anesthesia Student Capstones. 58.