Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section

Js, Thomas; Koh, SH; Cooper, G. M.

doi:10.1093/bja/ael302

Cited by 273 publications

(182 citation statements)

References 9 publications

Supporting

Mentioning

164

Contrasting

Unclassified

Order By: Relevance

“…bolus. 28 Overall, symptoms were much less frequent compared with frequencies reported in previous studies. 1,4 Palmer et al 1 reported all complaints and, in the study by Moran et al, 4 patients were asked for symptoms per-operatively, which could explain differences besides the differences in doses and in the way the drug was administered.…”

Section: Discussionmentioning

confidence: 52%

“…Blood pressure and HR were measured with 2-minutes interval and the short-acting effect of oxytocin on haemodynamic variables may have been underestimated. 7,9,28 This could explain why the decrease in MAP was less pronounced compared with other studies. 5,7,28 The non-invasive method was chosen in order to encourage patients to agree to participate in the study.…”

Section: Discussionmentioning

confidence: 72%

“…31 Recent studies suggest that the oxytocin dose given during elective CS could be reduced and that an infusion gives haemodynamic advantages. 28,[32][33][34] It is possible that ST depressions could be prevented by a slow infusion of oxytocin since the haemodynamic adverse-effects will be less marked with this method. 28 The results of the present study applies to healthy women during elective CS and the clinical importance of the findings could be questioned as only a few patients had symptoms and the ECG changes suggestive of myocardial ischaemia resolved after a short duration of time.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

View full text Add to dashboard Cite

Objective To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.Design Double-blind randomised controlled trial Setting University hospital in Sweden.Population A total of 103 healthy women undergoing elective caesarean section under spinal anaesthesia.Methods The participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively.Main outcome measures Depression of the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss.Results There was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3). Decrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and 17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss.Conclusion ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

View full text Add to dashboard Cite

show abstract

“…It is unclear whether reducing the administered dose of carbetocin may further reduce the incidence of this unwanted effect; therefore, further studies are warranted. Furthermore, although it is well established that oxytocin given by infusion produces fewer hemodynamic effects than when given by bolus, 18 less is known about the method of administration of carbetocin. It remains unclear why the manufacturer has recommended administration of carbetocin as an intravenous bolus over one minute.…”

Section: Discussionmentioning

confidence: 99%

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose, part 2

Anandakrishnan

Balki

Farine

et al. 2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose The aim of this study was to determine the intravenous dose of carbetocin required to produce effective uterine contraction in 95% of women (ED 95 ) undergoing elective Cesarean delivery under spinal anesthesia. Methods One hundred and twenty term pregnant women at low risk for postpartum hemorrhage (PPH) undergoing elective Cesarean delivery under spinal anesthesia were randomly allocated to receive carbetocin in doses of 20, 40, 60, 80, or 100 lg iv upon delivery of the fetus. The obstetrician evaluated the efficacy of uterine tone as satisfactory or unsatisfactory, and in case of unsatisfactory tone, additional uterotonics were administered as per routine institutional practice. The primary outcome measure was satisfactory uterine tone at two minutes after carbetocin administration, and the secondary outcomes were the estimated blood loss, need for additional uterotonic agents within 24 hr, and side effects. Results Overall satisfactory uterine tone at two minutes was observed in 94.2% (113/120) of the women, and there was no difference across the different study groups. It was not possible to calculate the ED 95 of carbetocin due to the even distribution of women with unsatisfactory uterine tone at two minutes across all dose groups (P = 0.60). Additional uterotonics within 24 hr were required in 13% (16/120) of the women. Side effects were similar across all dose groups, with an overall 42.5% incidence of hypotension following the administration of carbetocin. Conclusions In women at low risk for PPH undergoing elective Cesarean delivery under spinal anesthesia, carbetocin is similarly effective in doses of 20-100 lg. There is a high incidence of hypotension associated with carbetocin in these doses. Further dose-finding studies are warranted, including doses lower than 20 lg. This trial was registered at www.clinicaltrials.gov (NCT01428817). RésuméObjectif L'objectif de cette étude était de déterminer la dose intraveineuse de carbétocine nécessaire à produire une contraction utérine efficace chez 95 % des femmes (DE 95

show abstract

“…Slow boluses or infusions of oxytocin have shown to reduce the cardiovascular effects of this drug. 19 Similarly, current recommendations suggest a slow intravenous bolus of carbetocin over one minute. 9, A It is not clear how this one-minute time frame was determined.…”

Section: Discussionmentioning

confidence: 99%

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Cordovani

Balki

Farine

et al. 2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose The primary objective of our study was to determine the minimum intravenous dose of carbetocin required to produce adequate uterine contraction in 95% of women (effective dose [ED] 95 ) undergoing elective Cesarean delivery (CD). Methods Eighty term pregnant women with low risk for postpartum hemorrhage (PPH) undergoing elective CD under spinal anesthesia were randomly allocated to receive carbetocin intravenously in doses of 80 lg, 90 lg, 100 lg, 110 lg, or 120 lg upon delivery. The consultant obstetrician evaluated the efficacy of the patient's uterine tone as satisfactory or unsatisfactory. In case of unsatisfactory uterine tone, additional uterotonics were administered as per routine institutional practice. Side effects were monitored during the study period. The main outcome measure was satisfactory uterine tone at two minutes after carbetocin administration. Results Satisfactory uterine tone was obtained in 70 subjects (87%) within the dose range of 80-120 lg of carbetocin. It was not possible to calculate the ED 95 of carbetocin due to the even distribution of women with satisfactory uterine tone across all dose groups (P = 0.99). Similarly, the side effects were similar across all dose groups. There was a high overall incidence of hypotension (55%) following the administration of carbetocin.Conclusions In women at low risk for PPH undergoing elective CD, carbetocin doses of 80-120 lg are similarly effective. There is a high incidence of hypotension associated with carbetocin in these doses, and further studies with doses lower than 80 lg are warranted to assess the balance of efficacy and side effects. This trial was registered at www.clinicaltrials.gov (NCT01262742). RésuméObjectif L'objectif principal de notre e´tude e´tait de de´terminer la dose intraveineuse minimum de carbe´tocine ne´cessaire pour obtenir une contraction ute´rine approprie´e chez 95 % des femmes (dose efficace [DE] 95 ) subissant une ce´sarienne programme´e. Méthodes Quatre-vingts femmes enceintes a`terme ayant un faible risque d'he´morragie du postpartum subissant une ce´sarienne programme´e sous rachianesthe´sie ont e´teŕ andomise´es pour recevoir des doses intraveineuses de 80 lg, 90 lg, 100 lg, 110 lg ou 120 lg de carbe´tocine au moment de l'accouchement. L'obste´tricien a e´valueĺ 'efficacite´du tonus ute´rin de la patiente comme satisfaisant ou non satisfaisant. En cas de tonus ute´rin non satisfaisant, des me´dicaments ute´rotoniques supple´mentaires ont e´teá dministre´s conforme´ment aux pratiques habituelles de l'e´tablissement. Les effets inde´sirables ont e´te´surveille´s pendant la dure´e de l'e´tude. Le crite`re de jugement principal a éte´un tonus ute´rin satisfaisant deux minutes apre`s l'administration de carbe´tocine.

show abstract

Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section

Abstract: We recommend that bolus doses should be used with caution, and further studies should ascertain if oxytocin is equally effective in reducing blood loss when given at a slower rate.

Cited by 273 publications

References 9 publications

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose, part 2

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Contact Info

Product

Resources

About