The Intraoperative Median Effective Dose of Oxytocin for Preventing Uterine Atony in Parturients with a Prior History of Caesarean Delivery.

Autor: Wei CN; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1, Hangzhou, 310006, China., Drzymalski D; Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA., Cao YF; Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, 314000, China., Ping ZP; Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, 314000, China., Wu H; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1, Hangzhou, 310006, China., Chen XZ; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1, Hangzhou, 310006, China. chenxinz@zju.edu.cn.
Jazyk: angličtina
Zdroj: Clinical drug investigation [Clin Drug Investig] 2021 Dec; Vol. 41 (12), pp. 1047-1053. Date of Electronic Publication: 2021 Oct 16.
DOI: 10.1007/s40261-021-01090-x
Abstrakt: Background and Objective: While oxytocin is commonly used for the prevention of uterine atony, its pharmacology may be affected by a prior history of caesarean delivery. The objective of this study was to determine the 50% effective dose (ED 50 ) of bolus oxytocin after caesarean delivery in parturients with and without prior caesarean delivery.
Methods: This was a parallel-group, double-blind, dose-response study using Dixon's up-and-down sequential allocation method to estimate the ED 50 of bolus-administered oxytocin in parturients having caesarean delivery under combined spinal-epidural anaesthesia (CSE). Twenty-seven parturients with a history of prior caesarean delivery (With-PCD group) and 26 parturients with no such history (Without-PCD group) were enrolled. Oxytocin was administered as an intravenous bolus at a starting dose of 0.5 units, which was then increased or decreased by 0.25 units at a time. Uterine tone was assessed by the obstetrician as either 'adequate' or 'inadequate' 3 min after delivery of the fetus. Adverse effects, administration of additional uterotonic agents, and estimated blood loss were recorded.
Results: The ED 50 of oxytocin was greater in the With-PCD group than in the Without-PCD group (0.95 units [95% CI 0.82-1.08] vs. 0.55 units [95% CI 0.38-0.73], P < 0.001). The overall incidence of adverse effects was higher in the With-PCD group than in the Without-PCD group (33.3% vs. 7.7%, P = 0.02).
Conclusion: The initial bolus dose of oxytocin needed to prevent uterine atony was higher in parturients with prior caesarean delivery than in parturients without prior caesarean delivery. Uterine scarring may contribute to the increased oxytocin requirements of the former group.
Trial Registration Number: ChiCTR1900023474; investigator: Wei CN; date of registration: 30 May 2019.
(© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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