Effect of Ondansetron on Intra-procedural Nausea and Vomiting in Patients Undergoing Transcatheter Aortic Valve...

Sedation has advantages for patients receiving transcatheter aortic valve replacement (TAVR) compared with general anesthesia. However, the beneficial effect of an antiemetic agent on intra-procedural nausea and vomiting (IPNV) remains unclear. Therefore, we aimed to evaluate whether ondansetron reduces IPNV in patients undergoing transfemoral TAVR with conscious sedation.

We conducted a single-center retrospective study, analyzing outcomes of 100 patients undergoing TAVR before (Before group, n=48) and after (After group, n=52) ondansetron administration. Conscious sedation was initiated with a bolus of 0.7 μg/kg and subsequent 0.1-0.4 μg/kg/h IV dexmedetomidine, supplemented with IV remifentanil and IV propofol to achieve a bispectral index <90 with a Richmond Agitation-Sedation Scale of -2 to -1. Only the After group received ondansetron 4 mg IV at the beginning of sedation. All patients underwent an ultrasound-guided right or left fascia iliaca block using 30 mL of 0.185% ropivacaine, depending on the sheath insertion side. The primary endpoint was IPNV incidence during TAVR procedures, with statistical significance set at P<0.05.

Groups were well balanced, with no significant differences in aortic stenosis severity, cardiac function, or comorbidities affecting heart function. The After group showed a significantly lower incidence of IPNV (0% vs. 22.9%, P<0.001 using the χ² test). No differences were observed in intra-operative vasopressor use, and no cases of suspected aspiration occurred.

Ondansetron prevented IPNV in transfemoral TAVR patients with conscious sedation. These results suggest that pretreatment with ondansetron may be a useful strategy for reducing aspiration risk in procedures requiring conscious sedation, including transfemoral TAVR.