Obstetric Anesthesia

Anesthesia for Cesarean Delivery

Five Unit Bolus Oxytocin at Cesarean Delivery in Women at Risk of Atony: A Randomized, Double-Blind, Controlled Trial

King KJ, Douglas MJ, Unger W, et al (John Hunter Hosp, New South Wales, Australia; British Columbia Women’s Hosp, Vancouver, Canada; et al) Anesth Analg 111:1460-1466, 2010^§

Abstract

Background

IV bolus oxytocin is used routinely during cesarean delivery to prevent postpartum hemorrhage. Its adverse hemodynamic effects are well known, resulting in a recent change in dose from 10 IU to 5. Whether a 5 IU bolus has any advantages over infusion alone is unclear. We tested the hypothesis that a 5 IU IV bolus of oxytocin before the initiation of a continuous infusion decreases the need for additional uterotonic drugs in the first 24 hours after delivery in women with risk factors for uterine atony undergoing cesarean delivery, compared with infusion alone.

Methods

A prospective, randomized, double-blind, controlled trial was conducted in 143 subjects undergoing cesarean delivery with at least 1 risk factor for uterine atony. Subjects received 5 IU bolus of oxytocin or normal saline IV over 30 seconds after umbilical cord clamping. All subjects received an infusion of 40 IU oxytocin in 500 mL normal saline over 30 minutes, followed by 20 IU in 1 L over 8 hours. The primary outcome was the need for additional uterotonics in the first 24 hours after delivery. Secondary outcomes included uterine tone as assessed by the surgeon (5-point Likert scale: 0 = “floppy,” 4 = “rock hard”), estimated blood loss, side effects of bolus administration, and the oxytocin bolus-placental delivery interval.

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