naa a22 4500 510744761 CHVBK 20180411083042.0 cr unu---uuuuu 180411e20131101xx s 000 0 eng 10.1007/s12630-013-0028-2 doi (NATIONALLICENCE)springer-10.1007/s12630-013-0028-2 Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose, part 2 [Elektronische Daten] [Suresh Anandakrishnan, Mrinalini Balki, Dan Farine, Gareth Seaward, Jose Carvalho] La carbétocine lors d'un accouchement par césarienne programmé: une étude randomisée contrôlée pour déterminer la dose efficace, 2e partie Purpose: The aim of this study was to determine the intravenous dose of carbetocin required to produce effective uterine contraction in 95% of women (ED95) undergoing elective Cesarean delivery under spinal anesthesia. Methods: One hundred and twenty term pregnant women at low risk for postpartum hemorrhage (PPH) undergoing elective Cesarean delivery under spinal anesthesia were randomly allocated to receive carbetocin in doses of 20, 40, 60, 80, or 100μg iv upon delivery of the fetus. The obstetrician evaluated the efficacy of uterine tone as satisfactory or unsatisfactory, and in case of unsatisfactory tone, additional uterotonics were administered as per routine institutional practice. The primary outcome measure was satisfactory uterine tone at two minutes after carbetocin administration, and the secondary outcomes were the estimated blood loss, need for additional uterotonic agents within 24hr, and side effects. Results: Overall satisfactory uterine tone at two minutes was observed in 94.2% (113/120) of the women, and there was no difference across the different study groups. It was not possible to calculate the ED95 of carbetocin due to the even distribution of women with unsatisfactory uterine tone at two minutes across all dose groups (P=0.60). Additional uterotonics within 24hr were required in 13% (16/120) of the women. Side effects were similar across all dose groups, with an overall 42.5% incidence of hypotension following the administration of carbetocin. Conclusions: In women at low risk for PPH undergoing elective Cesarean delivery under spinal anesthesia, carbetocin is similarly effective in doses of 20-100μg. There is a high incidence of hypotension associated with carbetocin in these doses. Further dose-finding studies are warranted, including doses lower than 20μg. This trial was registered at www.clinicaltrials.gov (NCT01428817). Canadian Anesthesiologists' Society, 2013 Anandakrishnan Suresh Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Farine Dan Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Seaward Gareth Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1054-1060 0832-610X 60:11<1054 2013 60 12630 https://doi.org/10.1007/s12630-013-0028-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0028-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Anandakrishnan Suresh Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Farine Dan Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Seaward Gareth Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1054-1060 0832-610X 60:11<1054 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer