Hemodynamic effects of ramosetron during total intravenous anesthesia with propofol and remifentanil: a randomized controlled trial

Ramosetron, a 5-HT 3 receptor antagonist, attenuates hypotension during spinal anesthesia, but its hemodynamic effects during total intravenous anesthesia (TIVA) remain unclear.This randomized, double-blind, placebo-controlled trial evaluated ramosetron's hemodynamic effects during propofol-remifentanil TIVA induction.A total of 183 patients (ASA I-II, aged 20-65 years) undergoing elective surgery were randomized to receive intravenous normal saline (control, n=62), ramosetron 0.3 mg (n=61), or ramosetron 0.6 mg (n=60) before TIVA induction.Hemodynamic parameters were measured serially from baseline to post-intubation.The primary endpoint was hemodynamic changes immediately before intubation.At the primary endpoint, no significant differences were observed among groups in changes in systolic blood pressure (p=0.190),diastolic blood pressure (p=0.107),mean arterial pressure (p=0.344), or heart rate (p=0.134).Although isolated statistically significant differences were observed post-intubation in systolic and mean arterial pressure changes (p=0.030,p=0.040), repeated measures ANOVA showed no significant time×group interaction (p>0.4).The incidence of hemodynamic adverse events was low and comparable among groups.Ramosetron 0.3 mg or 0.6 mg did not significantly affect hemodynamic changes during propofol-remifentanil TIVA induction.Ramosetron can be safely used for postoperative nausea and vomiting prophylaxis without compromising hemodynamic stability.However, evidence supporting its use primarily for blood pressure stabilization during TIVA is insufficient, as hemodynamic benefits observed in spinal anesthesia do not translate to TIVA settings.