title: Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen.
abstract: BACKGROUND
  Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients.
  
  
  OBJECTIVE
  To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion.
  
  
  METHODS
  Randomized, double-blind, active controlled trial.
  
  
  METHODS
  Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted.
  
  
  RESULTS
  There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group.
  
  
  CONCLUSIONS
  Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events.
authors.affiliation: Department of Anaesthesiology, Burdwan Medical College, Kolkata, West Bengal, India.
authors.forename: Susmita
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Sarmila
authors.initials: S
authors.lastname: Ghosh
authors.forename: Debanjali
authors.initials: D
authors.lastname: Ray
authors.forename: Suchismita
authors.initials: S
authors.lastname: Mallik
authors.forename: Arpita
authors.initials: A
authors.lastname: Laha
keywords: Cesarean delivery; hemodynamic change; oxytocin; uterine tone