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12. Oxytocin versuscarbetocin at elective Cesarean delivery in parturients with class III obesity: a double-blind randomized controlled noninferiority trial

Author

Turner, William, Boonstra, Linda, Maxwell, Cynthia, Downey, Kristy, and Balki, Mrinalini

Abstract

Purpose: Class III obesity (body mass index [BMI] ≥ 40 kg·m−2) is associated with high rates of Cesarean deliveries and postpartum hemorrhage, with increased maternal and fetal morbidity. The doses of oxytocin and carbetocin are two to four times higher at Cesarean delivery in patients with class III obesity. We sought to investigate the efficacy of carbetocin 80 µg ivcompared with oxytocin 1 IU iv(plus infusion) at elective Cesarean delivery in parturients with class III obesity. We hypothesized that, with equipotent dosing, carbetocin would be noninferior to oxytocin. Methods: We conducted a randomized, double-blind, noninferiority study in nonlabouring, term parturients with BMI ≥ 40 kg·m−2undergoing elective Cesarean delivery under neuraxial anesthesia. Patients received either a 1-IU bolus of oxytocin ivfollowed by an infusion of 4.8 IU·hr−1or an 80-µg carbetocin bolus ivfollowed by a placebo infusion. Uterine tone was determined by palpation by the obstetrician at 3, 5, and 10 min, using a verbal numerical rating score of 0 (boggy) to 10 (firm). The primary outcome was uterine tone at 3 min. Secondary outcomes included uterine tone at 5 and 10 min, blood loss, additional uterotonics, and side effects. Results: Forty-seven participants were included in the analysis. Median tone at 3 min was similar for oxytocin (8; 95% confidence interval [CI], 7 to 8) and carbetocin (8; 95% CI, 8 to 9) (P= 0.06), with no difference at 5 and 10 min. Blood loss, side effects, and the need for additional uterotonics were not significantly different between the study groups. Conclusion: We conclude that carbetocin is noninferior to oxytocin at elective Cesarean delivery in parturients with class III obesity, with the advantage of single bolus dosing without infusion. Study registration: ClinicalTrials.gov (NCT04902729); first submitted 21 May 2021.

Published
2025
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15. In Response

Author

Peska, Emil, primary, Balki, Mrinalini, additional, Pfeifer, Wesla, additional, Maxwell, Cynthia, additional, Ye, Xiang Y., additional, Downey, Kristi, additional, and Carvalho, Jose C. A., additional

Published
2024
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25. In Response

Author

Medische staf Anesthesiologie, van den Bosch, Oscar F C, Chaudhry, Rabail, Wicker, James, Mubashir, Talha, Limb, Daniel, Jogendran, Rohit, Munshi, Laveena, Balki, Mrinalini, Medische staf Anesthesiologie, van den Bosch, Oscar F C, Chaudhry, Rabail, Wicker, James, Mubashir, Talha, Limb, Daniel, Jogendran, Rohit, Munshi, Laveena, and Balki, Mrinalini

Published
2023

29. Remifentanil for labor analgesia: a comprehensive review

Author

Ohashi, Yayoi, Baghirzada, Leyla, Sumikura, Hiroyuki, and Balki, Mrinalini

Subjects
Complications and side effects, Research, Methods, Dosage and administration, Remifentanil -- Dosage and administration -- Complications and side effects, Pain management -- Comparative analysis -- Methods -- Research
Abstract

Author(s): Yayoi Ohashi[sup.1] , Leyla Baghirzada[sup.2] , Hiroyuki Sumikura[sup.3] , Mrinalini Balki[sup.4] Author Affiliations: (1) Department of Anaesthesia, Fremantle Hospital and Health Service, Alma Street, 6160, Fremantle, WAAustralia (2) Department [...], Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world. Intravenous patient-controlled analgesia (IVPCA) with remifentanil is considered to be a reasonable option for labor pain relief. Several studies have demonstrated its efficacy with minimal maternal and neonatal adverse effects. On the other hand, reports of cases of maternal cardiac and respiratory arrest with remifentanil IVPCA within the past couple of years have redirected our attention to its safe use. Remifentanil IVPCA warrants one-to-one nursing monitoring, appropriate education of healthcare providers, continuous maternal oxygen saturation monitoring, end-tidal CO.sub.2 monitoring, and availability of both maternal and neonatal resuscitation equipment. This article provides an overview of knowledge and principles of using remifentanil IVPCA for labor analgesia and introduces its potential usage in Japan.

Published
2016
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33. In Response

Author

Patel, Ruchira, Arzola, Cristian, Petrounevitch, Vitali, Balki, Mrinalini, Downey, Kristi, Tsui, Ban C. H., and Carvalho, Jose C. A.

Published
2017
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42. Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care

Author

Warrick, Christine M., primary, Markley, John C., additional, Farber, Michaela K., additional, Balki, Mrinalini, additional, Katz, Daniel, additional, Hess, Philip E., additional, Padilla, Cesar, additional, Waters, Jonathan H., additional, Weiniger, Carolyn F., additional, and Butwick, Alexander J., additional

Published
2022
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