A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand
A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand
复制标题
澳大利亚和新西兰选择性剖腹产麻醉师使用宫缩剂的调查
DOI：
10.1177/0310057x211002838
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发表时间：
2021
影响因子：
1.5
通讯作者：
J. Sharman
中科院分区：
文献类型：
--
作者：
N. Terblanche;P. Otáhal;J. Sharman
预防性使用宫缩剂可确保选择性剖腹产时子宫充分收缩，以防止大量出血。英国皇家妇产科学院指南建议以 5 IU 的剂量“缓慢推注”催产素，但临床实践中存在差异。本研究旨在通过对澳大利亚和新西兰产科麻醉特别兴趣小组的麻醉师成员进行调查，以确定选择性剖腹产的信念和宫缩使用实践。调查问卷通过电子邮件发送给产科麻醉特殊兴趣小组成员，回复率为 33%，并对 279 份已完成的报告进行了分析。催产素是最常用的一线子宫收缩剂，但催产素丸剂的使用存在广泛差异。 38% 的麻醉师常规使用英国皇家妇产科学院指南推荐的 5 IU，而 38% 的麻醉师倾向于低剂量（<5 IU）、10% 高剂量（≥10 IU）催产素和 13% 卡贝缩宫素（100 µg）。超过 50% 的人认为指南推荐的 5 IU 的证据薄弱。还发现催产素给药持续时间存在很大差异。 58% 的麻醉师常规进行后续催产素输注，最常见的是 40 IU，持续 4 小时，但剂量（10-40 IU）和给药持续时间（1 小时至≥6 小时）存在显着差异。总之，澳大利亚和新西兰麻醉师在选择性剖腹产术中催产素的使用实践存在显着差异。这种差异可能是由于缺乏强有力的证据来指导实践。这强调了在这一临床重要领域进行高质量试验的必要性。
Prophylactic administration of uterotonics ensures adequate uterine contraction at elective caesarean section to prevent substantial haemorrhage. Royal College of Obstetricians and Gynaecologists guidelines advise the administration of oxytocin at 5 IU as a ‘slow bolus’ but there are variations in clinical practice. This study aimed to determine the beliefs and uterotonic usage practices at elective caesarean section by surveying anaesthetist members of the Obstetric Anaesthesia Special Interest Group in Australia and New Zealand. Questionnaires were emailed to Obstetric Anaesthesia Special Interest Group members and the response rate was 33%, with analysis of 279 completed reports. Oxytocin was the most commonly used first-line uterotonic, but extensive variation in oxytocin bolus use was identified. Thirty-eight per cent of anaesthetists routinely administered Royal College of Obstetricians and Gynaecologists guideline-recommended 5 IU, whereas 38% favoured low dose (<5 IU), 10% high dose (≥10 IU) oxytocin and 13% carbetocin (100 µg). More than 50% felt the evidence was weak for guideline-recommended 5 IU. Wide variation in the duration of oxytocin administration was also identified. Fifty-eight per cent of anaesthetists routinely gave follow-up oxytocin infusions, most commonly at 40 IU over 4 hours, but there was significant variation in the dosage (10–40 IU) and administration duration (1 hour to ≥6 hours). In conclusion, there is significant variation in oxytocin usage practices at elective caesarean section among Australian and New Zealand anaesthetists. This variation may be due to a lack of strong evidence to guide practice. This emphasises the need for high quality trials in this clinically important area.