Zofran Can! Well, sorta, when it comes to the Bezold-Jarisch reflex…

To cap off this week’s case discussion, we’d like to return to the last teaser of a question:

What does ondansetron have to do with hypotension when the Bezold-Jarisch reflex is involved?

This article from RA&PMdescribes ondansetron’s possible role in hypotension, the Bezold-Jarisch reflex, and neuraxial anesthesia. Importantly, this review concerns spinal, and not epidural, anesthesia. However the mechanism described may also function similarly following hypotension and bradycardia seen with epidurals.

More literature can be found here. A nice review of the Bezold-Jarisch reflex itself from the BJA in 2001 can be found here.

For the pharmacologists and structural biologists among us, here is a very cool Wikipedia article on the discovery and drug development of seratonin receptor antagonists.

Kudos to Drs. Lucas and Koyyalamundi for picking up on the involvement of seratonin in this reflex through their comments this week.

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