If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Re: Ephedrine can contribute to tachycardia
- Jeremy S Thomas (5 February 2007)
-
Haemodynamic changes with oxytocin bolus after Caesarean section : A case report
- Ashish Rajkumar, Ashish Dhawan, Cardiologist, Stockport (29 January 2007)
-
Ephedrine can contribute to tachycardia
- Dr. M.Rahim Kayani (26 January 2007)
-
Effects of Oxytocin bolus Vs. infusion on cardiovascular system
- Dr Priyanka Surve (22 January 2007)
-
Oxytocin bolus vs infusion in obstetric anaesthesia
- Surendra Singh (7 December 2006)
|
|
|||
|
Jeremy S Thomas, Cons Anaesthetist
Send letter to journal:
|
In response to your letter can I clarify that no ephedrine was given during the study period, ie the five minutes shown in the two figures. The tachycardia shown is solely in response to the bolus of oxytocin as is the drop in MAP. Ephedrine was used after siting the spinal anaesthetic. The total amount used in both groups was similar (see table 1). Ephedrine was chosen as it has remained the agent of choice prior to delivery until very recently. We took every effort to ensure there were no confounding factors that could be responsible for differences between the groups. In two patients we were unable to do so and they had to be excluded due to haemodynamic instability shortly before the study period. I hope this reassures you that the results are valid and that oxytocin given as a bolus or infusion will produce these cardiovascular changes seen in the figures. Conflict of Interest:None declared |
|||
|
|
|||
|
Ashish Rajkumar, Anaesthetist , Ashish Dhawan, Cardiologist, Stockport
Send letter to journal:
|
Editor, I read with interest the article by Thomas JS and colleagues(1) regarding haemodynamic effects of oxytocin bolus. I agree with the authors and would like to share my experience. I had a 33 year old fit and well lady for elective Caesarean section. She had spinal anaesthesia with 2.5 ml 0.5% hyperbaric bupivacaine and 20 µg fentanyl. Her preoperative heart rate was 110 beats/min. She did not need any vasopressor during the operation. There was no significant blood loss. After the baby was delivered, she was given 5 units of oxytocin diluted in 5 ml normal saline. Her heart rate increased to 175 beats/min immediately after oxytocin bolus. Her heart rate was above 170 beats/min even 15 minutes after the surgeons finished Caesarean section. 12 lead ECG was suggestive of atrial fibrillation and cardiology opinion was sought. Since lady wanted to breast feed, cardiologist opted for single bolus dose of digoxin rather than amiodarone. She was advised to extract and discard breast milk for first 24 hours due to digoxin bolus. She developed sinus rhythm in half an hour after digoxin bolus and breast feeding was resumed next day. Since the incident, I have stopped using oxytocin bolus. I have the same practice of giving slow infusion of oxytocin as suggested by authors. A Rajkumar Stockport, UK E-mail: ashish_rj@yahoo.co.uk References 1.Thomas JS, Koh SH, et al. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section. B J Anaes 2007; 98;116-19 Conflict of Interest:None declared |
|||
|
|
|||
|
Dr. M.Rahim Kayani
Send letter to journal:
|
We read with interest the article by Thomas et al (1). It is unfortunate that in this comparison, the timing of the ephedrine administration was not made clear. Ephedrine itself causes tachycardia, cardiac arrhythmias, ,vasoconstriction with hypertension. Co administrated sympathomimetics can have variable response in individuals unrelated to oxytocin administration and it is not clear from this article that the authors took this into account. This must call into doubt the validity of the findings. We suggest that metaraminol might be a more appropriate anti hypotensive agent in view of fewer confounding effects that would not mask oxytocin induced side effects. Reference J. S. Thomas, S.H. Koh, and G. M. Cooper Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section BJA Advance Access published on December 2, 2006 Br. J. Anaesth. 2007 98: 116-119
D Kruchek FRCA M Kayani MB BS Dept of Anaesthetics Ashford and St Peters NHS Trust Chertsey Conflict of Interest:None declared |
|||
|
|
|||
|
Dr Priyanka Surve, Anaesthetist
Send letter to journal:
|
Dear Editor, I would like to congratulate the authors on their study on the Haemodynamic effects of oxytocin given as i.v. bolus or infusion on woman undergoing Caesarean section. As an anaesthetist, we all like our patients to be cardiovascularly stable throughout the caesarean section. I have observed on few occassions, considerable fall in Mean Arterial Pressure and patient complaining of nausea, vomiting and faintness after bolus dose of oxytocin. I do agree that cardiovascular side effects can be minimised by giving infusion of oxytocin over five minutes. I have also observed a few patients complaining pain on injection of bolus dose of oxytocin which can be prevented by giving infusion. Conflict of Interest:None declared |
|||
|
|
|||
|
Surendra Singh, Additional Professor SGPGI, Lucknow, INDIA
Send letter to journal:
|
I agree with the authors that oxytocin as a bolus has a greater haemodynamic effects than as an infusion given over a 5 min period. The reduction in blood loss needs to be compared between these two methods of oxytocin administration. A pronounced facial flush is a typical complaint of patients receiving oxytocin bolus having the caesarian section done under epidural or spinal anaesthesia. Conflict of Interest:None declared |
|||