Effect of an Educational Presentation to Increase Preemptive ondansetron Administration for Reducing Spinal-Induced Hypotension and Bradycardia

Background: The utilization of lower extremity total joint arthroplasty (TJA) has increased over time, with over 2.2 million hip and knee arthroplasty procedures performed between 2012 and 2020. These procedures are very painful for patients; therefore, providers may choose to perform a neuraxial anesthesia to block the initiation and conduction of the pain nerve pathway. However, there are side effects from neuraxial anesthesia. Hypotension and bradycardia from neuraxial anesthesia are common side effects and are caused from the blocks ability to elicit the Bezold-Jarisch reflex (BJR). A prophylactic administration of the medication ondansetron (Zofran®), can attenuate some side effects of spinal anesthesia. Purpose: This project was developed to educate anesthesiologists and CRNAs that there is a new safe and effective intervention to add to their current practice. To attenuate the side effects from choosing a neuraxial anesthetic for patients undergoing a total knee arthroplasty. Methods: This DNP project collected quantitative data through electronic pretests and posttest. A retrospective chart review was conducted to evaluate if there was an increase in prophylactic administration of ondansetron (Zofran®) prior to a spinal anesthetic after participating in an educational presentation. Implementation: Five anesthesia providers at a rural hospital in northern Indiana participated in this project. The providers were given an online pre-test and then once completed there was a link provided with education from a PowerPoint presentation. Following the presentation, a post-test was administered. Additionally, a retrospective chart review was conducted three months before and three months after the educational intervention to determine if a practice change had been made regarding the timing of ondansetron administration. Conclusion: The introduction of an education intervention suggest a generalized improvement in knowledge about prophylactic administration of ondansetron for total knee arthroplasty under a spinal anesthetic, the Bezold-Jarisch reflex, and alternative interventions in pre-test to post-test scores despite not being statistically significant. Additionally a retrospective chart review indicated that before the educational intervention, successful prophylactic administration of ondansetron prior to a spinal anesthetic improved and incorrect administrations decreased post-educational presentation.

Creator

• Brandes, Cody

Language

• English

Keyword

• Ondansetron
• Spinal
• Lower extremity total joint
• Neuraxial
• Spinal induced hypotension
• Spinal-induced hypotension Co-loading
• Zofran®
• Total joint arthroplasty (TJA)
• Bezold-Jarisch Reflex (BJR)
• attenuate
• vasopressors

Date created

• 2024-04-24

Resource type

• Research Paper

Rights statement

• http://rightsstatements.org/vocab/InC/1.0/