title: Uterotonics and tocolytics for anesthesiologists.
abstract: OBJECTIVE
  Obstetric anesthesiologists are supposed to understand the uterotonics and tocolytics used in the perinatal period to provide a better clinical practice. This review describes current consensus of uterotonics and tocolytics used in the perinatal period that an obstetric anesthesiologist should know.
  
  
  RESULTS
  Rational use of uterotonics for cesarean section has been well studied in the past decades. Oxytocin remained as a first line uterotonics for cesarean section. For continuous infusion, it is reported that ED90 is higher for laboring parturients than for nonlaboring parturients (6.2 vs. 44.2 IU/h) implying that protocol for oxytocin infusion should be different between laboring patients with prior exposure to oxytocin and nonlaboring patients. For bolus administration, 'rule of three' has been proposed and its efficacy has been reported. When oxytocin fails to achieve sufficient uterine contraction, second-line agents must be administered, and it has been reported that methylergonovine is a superior second-line uterotonic to carboprost. On the other hand, the role of tocolytic agents in obstetric anesthesia has not been well studied.
  
  
  CONCLUSIONS
  Anesthesiologists involved in obstetric anesthesia should be able to determine the appropriate uterotonic for cesarean section and know the indication of tocolytics in perinatal period.
authors.affiliation: Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sumikura
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
mesh_terms: D000072080:Anesthesiologists; D002585:Cesarean Section / Q000379:methods*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D007752:Obstetric Labor, Premature / Q000188:drug therapy; D010120:Oxytocics / Q000494:pharmacology / Q000627:therapeutic use*; D018743:Perinatal Care / Q000379:methods*; D018457:Placenta, Retained / Q000188:drug therapy; D011247:Pregnancy; D015149:Tocolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019687:Uterine Inversion / Q000188:drug therapy; D014599:Uterus / Q000187:drug effects*; D014710:Version, Fetal / Q000379:methods
chemical_list: D010120:Oxytocics; D015149:Tocolytic Agents