BJA Advance Access originally published online on October 9, 2008
British Journal of Anaesthesia 2008 101(6):822-826; doi:10.1093/bja/aen273
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Intravenous oxytocin bolus of 2 units is superior to 5 units during elective Caesarean section
1 Department of Anaesthesia, Intensive Care and Perioperative Medicine
2 Department of Obstetrics and Gynaecology, Cairns Base Hospital, The Esplanade, Cairns, QLD 4870, Australia
3 Department of Anaesthesia, Mater Health Services Brisbane, South Brisbane, QLD 4101, Australia
4 Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
* Corresponding author. E-mail: james_sartain{at}health.qld.gov.au
Background: The optimal dose of oxytocin at Caesarean section is unclear. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomized double-blind trial.
Methods: Eighty patients undergoing elective Caesarean section received an i.v. bolus of either 2 or 5 units (u) of oxytocin after delivery, followed by an oxytocin infusion of 10 u h–1. All received combined spinal–epidural anaesthesia with arterial pressure maintained by a phenylephrine infusion. We compared changes in heart rate (HR), mean arterial pressure (MAP), blood loss, uterine tone, the need for additional uterotonic drugs, and emetic symptoms.
Results: There was a greater increase in mean (SD) HR in patients who received 5 u of oxytocin [32 (17) beats min–1] than in those who received 2 u [24 (13) beats min–1] (P=0.015). There was a larger decrease in MAP in patients who received 5 u [13 (15) mm Hg] than in those who received 2 u [6 (10) mm Hg] (P=0.030). The frequency of nausea and antiemetic use was higher after 5 u (32.5%) than 2 u (5%) (P=0.003). There were no differences in blood loss, uterine tone, or requests for additional uterotonic drugs (17.5% in both groups).
Conclusions: In elective Caesarean section, a 2 u bolus of oxytocin results in less haemodynamic change than 5 u, with less nausea and no difference in the need for additional uterotonics.
Keywords: anaesthesia, obstetric; complications, hypotension; uterus, oxytocin; vomiting, nausea, anaesthetic factors
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