Effect of Ondansetron on Intra-procedural Nausea and Vomiting in Patients Undergoing Transcatheter Aortic Valve Replacement With Conscious Sedation: A Before-and-After Study.

PURPOSE: 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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.