Effective Dose of Prophylactic Oxytocin Infusion During Cesarean Delivery in 90% Population of Nonlaboring Patients With Preeclampsia Receiving Magnesium Sulfate Therapy and Normotensives: An Up-Down Sequential Allocation Dose-Response Study

Tyagi, Asha; Mohan, Aparna; Singh, Yuvraj; Luthra, Ankit; Garg, Devansh; Malhotra, Rajeev

doi:10.1213/ane.0000000000005701

Cited by 11 publications

(6 citation statements)

References 22 publications

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“…( Lavoie et al, 2015 ). Tyagi et al, 2022 evaluated the ED90 of preventive oxytocin infusion in pregnant women with preeclampsia who were also getting magnesium therapy and compared it to normotensive pregnant females. The findings demonstrated a significant rise in the ED90 among persons who were administered magnesium sulfate compared to those who were not (24.9 IU/h vs. 13.9 IU/h).…”

Section: Discussionmentioning

confidence: 99%

Oxytocin infusion dose-response to maintain uterine tone in obese elective cesarean patients: a randomized controlled trial

Yan,

Ai,

Huang

et al. 2024

Front. Pharmacol.

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BackgroundFor cesarean delivery (CD), the 90% effective dosage (ED90) of oxytocin for a first bolus has been established. It is not yet known how much oxytocin to inject into obese women undergoing elective discectomy to keep their uterine tone (UT) appropriate. We hypothesized that patients who are overweight need a greater dose of oxytocin infusion; thus, we aimed to determine how the dose-response curve for oxytocin infusion changes following an initial 1 international unit (IU) bolus in obese women undergoing elective CD.MethodsOne hundred parturients with a body mass index (BMI) greater than 30 kg/m2 were randomly assigned to receive an infusion rate of 14, 18, 22, or 26 IU/h of oxytocin. When the uterine palpation is as hard as touching the forehead or tip of the nose, it is considered sufficient UT according to the criteria used by obstetricians. The median effective dose (ED50) and ED90 values were determined using probit analysis.ResultsWe found the ED50 and ED90 values for the infusion dose of oxytocin were around 11.0 IU/h and 19.1 IU/h, respectively. Each group had a different number of parturients who needed rescued oxytocin: 14 IU/h for six, 18 IU/h for three, one for 22 IU/h, and none for 26 IU/h. The correlation between the frequency of rescued oxytocin administration and the amount of oxytocin infusion needed to avoid uterine atony was statistically significant (p = 0.02).ConclusionThe present research showed that the most effective dosage of oxytocin infusion for obese parturients undergoing elective CD is 19.1 IU/h, following an initial loading dose of 1 IU. Patients with obesity should receive a greater dosage of prophylactic oxytocin, and further studies comparing patients with and without obesity (with higher BMI) are required.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=159951, identifier ChiCTR2200059582.

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Section: Discussionmentioning

confidence: 99%

Oxytocin infusion dose-response to maintain uterine tone in obese elective cesarean patients: a randomized controlled trial

Yan,

Ai,

Huang

et al. 2024

Front. Pharmacol.

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“…They found that women with a BMI ≥ 40 kg.m − 2 required more than twice the oxytocin dose than women with a BMI < 40 kg.m − 2 (0.78 vs. 0.35 IU) 3 . Tyagi et al 4 compared the ED90 of prophylactic oxytocin infusion in patients with pre-eclampsia (who received magnesium therapy) and normotensive pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…1 Many factors can in uence the oxytocin dose required for maintaining uterine tone (UT) in cesarean delivery, including intrapartum delivery, obesity, and preeclampsia. [2][3][4] Thus, the recommendation is not suitable for all kinds of population.…”

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confidence: 99%

Oxytocin infusion for maintenance of uterine tone under prophylactic phenylephrine infusion for prevention of post-spinal hypotension in cesarean delivery: a prospective randomised double-blinded dose-finding study.

Jin,

Shen,

et al. 2023

Preprint

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Background: Prior studies have shown that, when administered as an intravenous bolus to prevent uterine atony, prophylactic phenylephrine infusion increased the dose requirement of oxytocin and second-line uterotonics. For the prevention of uterine atony, oxytocin should be delivered by continuous infusion. Here, we aimed to determine the ED50 and ED90 parameters (the effective doses for 50% and 90% patients without uterine atony) of oxytocin for co-infusion with prophylactic phenylephrine during cesarean delivery. Methods: In this prospective randomized double-blinded dose-finding study, one hundred patients were divided into four groups to receive 2.5, 5.0, 7.5, or 10 IU/h oxytocin infusion, after the umbilical cord was clamped during the study period. The uterine tone was evaluated and defined as either adequate or inadequate. Probit regression analysis was applied to calculate the ED50 and ED90 of oxytocin infusion. Uterine tone, the percentage of patients who needed additional oxytocin bolus, second-line uterotonics, side effects, estimated blood loss, and neonatal outcomes were monitored. Results: The estimated ED50 and ED90 values of the oxytocin infusion doses for the prevention of uterine atony were 1.9 IU/h (95% CI -4.6-3.8) IU/h and 9.3 IU/h (95% CI 7.3-16.2) IU/h, respectively. Across groups, there was a significant linear trend between the infusion dose and the percentage of patients who required additional oxytocin (p-value = 0.002). No differences were observed in the incidence of side effects and neonatal outcomes. Conclusion: Under the conditions of this study, the ED90 of oxytocin infusion for the prevention of uterine atony was 9.3 IU/h, which is higher than the current recommendation. This finding is helpful for clinical practice, because of the routine use of phenylephrine in cesarean delivery. Further studies are needed to determine the appropriate initial bolus of oxytocin after neonatal delivery. Trial registration: The study was registered on the Chinese Clinical Trial Register (register no. ChiCTR2200059556). RUL: https://www.chictr.org.cn/showproj.html?proj=153116

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“…This ratio of probabilities (ie, the biased coin) helps ensure that the doses administered gravitate toward levels with high success rates. The choice of a 9/10 to 1/10 biased coin was based on the methods used in the prior ED90 dose-finding trial of Lavoie et al 15 and others, 16 although the original biased-coin design as outlined in Pace and Stylianou 10 and Oron et al 13 proposed the use of an 8/9 to 1/9 biased coin for estimating the ED90. The biased-coin allocation after each successful response was implemented using a computer-generated list prepared by the statistician using R statistical software (R Foundation for Statistical Computing).…”

Section: Methodsmentioning

confidence: 99%

Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine

Maeda,

Villela-Franyutti,

Lumbreras-Marquez

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: The dural puncture epidural (DPE) technique has a faster onset, better sacral spread, and improved bilateral coverage when compared to the conventional epidural (EPL) technique. Whether these qualities translate into a lower bupivacaine dose to provide initial analgesia is unknown. We sought to determine the effective dose of bupivacaine to achieve initial (first 30 minutes) labor analgesia in 90% of patients (ED90) with the DPE and EPL techniques, using a biased-coin, sequential allocation method. METHODS: A total of 100 women of mixed parity with term, singleton gestation at ≤5 cm dilation with no major comorbidities were randomized to receive a DPE or an EPL technique. An experienced anesthesiologist performed these techniques and administered an allocated dose of plain bupivacaine diluted with isotonic sterile 0.9% saline to a total volume of 20 mL via the EPL catheter. Bupivacaine doses for each subject were determined by the response of the previous subject, using a biased-coin sequential allocation method, with success defined by a numeric rating scale (NRS) < 3 at 30 minutes. Outcome assessments were performed by an investigator blinded to the technique and bupivacaine dose. Sensory and motor blockade and maternal or fetal side effects were recorded every 5 minutes for the first 30 minutes. The ED90 of bupivacaine with each technique was estimated using centered isotonic regression. RESULTS: A total of 95 women were included in the final analysis. The ED90 of bupivacaine was estimated at 29.30 mg (90% confidence interval [CI], 28.55–31.56) with a DPE technique and 45.25 mg (90% CI, 42.80–52.03) with an EPL technique. CONCLUSIONS: Using a biased-coin, sequential allocation method, the DPE technique requires less bupivacaine to achieve effective initial analgesia (ED90) when compared to the EPL technique.

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Effective Dose of Prophylactic Oxytocin Infusion During Cesarean Delivery in 90% Population of Nonlaboring Patients With Preeclampsia Receiving Magnesium Sulfate Therapy and Normotensives: An Up-Down Sequential Allocation Dose-Response Study

Cited by 11 publications

References 22 publications

Oxytocin infusion dose-response to maintain uterine tone in obese elective cesarean patients: a randomized controlled trial

Oxytocin infusion dose-response to maintain uterine tone in obese elective cesarean patients: a randomized controlled trial

Oxytocin infusion for maintenance of uterine tone under prophylactic phenylephrine infusion for prevention of post-spinal hypotension in cesarean delivery: a prospective randomised double-blinded dose-finding study.

Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine

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