Atrial fibrillation after ondansetron for the prevention and treatment of postoperative nausea and vomiting: a case report
Abstract PurposeEven though clinical safety has been established in large studies, ondansetron has been reported to cause adverse cardiovascular events. We present a case of atrial fibrillation in association with ondansetron in the postoperative period.
Clinical featuresA 47-yr-old, 81 kg female presented with a benign lump in her left breast for lumpectomy. Her past medical history was unremarkable. Physically she was very active, non-smoker and had no allergies. She underwent the procedure under general anesthesia. She received 4 mg of ondansetron intravenously for postoperative nausea and vomiting prophylaxis at the end of the procedure and an additional 4 mg in the recovery room for nausea. Within 15 min after the second dose she was noted to be in atrial fibrillation that required admission to the hospital and procainamide infusion for conversion to normal sinus rhythm. She did not have any evidence of myocardial ischemia, valvular abnormality or pulmonary embolism.
ConclusionThe 5-hydroxytryptamine 3 receptor (5-HT3) antagonist ondansetron has been reported to cause myocardial ischemia, supraventricular and ventricular tachycardia. Postulated mechanism includes inhibition of Bezold-Zarisch cardiac reflex and coronary vasoconstriction. Inhibition of S-HT3 receptors in the heart could lead to unopposed action of other serotonin receptors leading to atrial fibrillation or other tachyarrhythmias described in the literature.
Résumé ObjectifMême si son innocuité clinique a été prouvée par de grandes séries, on a démontré que l’ondansétron peut avoir des effets cardiovasculaires indésirables. Nous présentons un cas de fibrillation auriculaire associée à l’ondansétron en période postopératoire.
Éléments cliniquesUne femme de 47 ans et de 81 kg a été admise pour l’exérèse locale d’une tumeur bénigne au sein gauche. Son histoire médicale était sans particularité. Elle était très active, non fumeuse et sans allergies. Elle a été opérée sous anesthésie générale. À la fin de l’opération, elle a reçu 4 mg d’ondansétron intraveineux contre les nausées et les vomissements postopératoires et, en salle de réveil, une dose supplémentaire de 4 mg contre les nausées. Moins de 15 min après la seconde dose, une fibrillation auriculaire a nécessité l’admission à l’hôpital et une perfusion de procaïnamide pour rétablir un rythme sinusal normal. Aucun indice d’ischémie myocardique, d’anomalie valvulaire ou d’embolie pulmonaire n’ont été mis en évidence.
ConclusionOn a déjà montré que l’ondansétron, antagoniste du récepteur 5-hydroxytryptamine 3 (5-HT3), pouvait causer de l’ischémie myocardique, de la tachycardie supraventri culaire et ventriculaire. Le mécanisme en cause pourrait être l’inhibition du réflexe cardiaque de Bezold-jarisch et la vasoconstriction coronaire. L’inhibition des récepteurs cardiaques de 5-HT3 peut entraîner une action non compensée d’autres récepteurs de sérotonine provoquant une fibrillation auriculaire ou d’autres tachyarythmies connues.
Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. ReferencesDomino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1370–9.
Castle WM, Jukes AJ, Griffiths CJ, Roden SM, Greenstreet YLA. Safety of ondansetron. Eur J Anaesthesiol 1992; 9(Suppl 6): 63–6.
Tolan MM, Fuhrman TM, Tsueda K, Lippmann SB. Perioperative extrapyramidal reactions associated with ondansetron (Letter). Anesthesiology 1999; 90: 340–1.
Blaine EM. Acute severe depression following perioperative ondansetron. S Afr Med J 1997; 87: 1013–4.
Bosek V, Hu P, Robinson L. Acute myocardial ischemia after administration of ondansetron hydrochloride. Anesthesiology 2000; 92: 885–7.
Baguley WA, Hay WT, Mackie KP, Cheney FW, Cullen BF. Cardiac dysrrhythmias associated with the intravenous administration of ondansetron and metoclopramide. Anesth Analg 1997; 84: 1380–1.
Ballard HS, Bottino G, Bottino J. Ondansetron and chest pain (Letter). Lancet 1992; 340: 1107.
Saxena PR, Villalon CM. 5-Hydroxytryptamine: a chameleon in the heart. Trends Pharmacol Sci 1991; 12: 223–7.
Saxena PR, Villalon CM. Cardiovascular effects of serotonin agonists and antagonists. J Cradiovasc Pharmacol 1990; 15(Suppl 7): S17-S34.
Boike SC, Llson B, Zariffa N, Jorkasky DK Cardiovascular effects of i.v. granisetron at two administration rates and of ondansetron in healthy adults. Am J Health-Syst Pharm 1997; 54: 1172–76.
Watanabe H, Hasegawa A, Shinozaki T, Arita S, Chigira M. Possible cardiac side effects of granisetron, an antiemetic agent in patients with bone and soft-tissue sarcomas receiving cytotoxic chemotherapy. Cancer Chemother Pharmacol 1995; 35: 278–82.
Kaumann AJ. Do human atrial 5-HT4 receptors mediate arrhythmias? Trends Pharmacol Sci 1994; 15: 451–5.
Division of Anesthesiology and Critical Care Medicine, E-30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195, Cleveland, Ohio, USA
Nagesha S. Kasinath, Osama Malak & John Tetzlaff
Correspondence to John Tetzlaff.
About this article Cite this articleKasinath, N.S., Malak, O. & Tetzlaff, J. Atrial fibrillation after ondansetron for the prevention and treatment of postoperative nausea and vomiting: a case report. Can J Anaesth 50, 229–231 (2003). https://doi.org/10.1007/BF03017789
Accepted: 06 November 2002
Issue Date: March 2003
DOI: https://doi.org/10.1007/BF03017789
RetroSearch is an open source project built by @garambo | Open a GitHub Issue
Search and Browse the WWW like it's 1997 | Search results from DuckDuckGo
HTML:
3.2
| Encoding:
UTF-8
| Version:
0.7.4