Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500003
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos de misoprostol sublingual pré-operatório no tônus uterino durante anestesia com isoflurano para cesariana

Effects of preoperative sublingual misoprostol on uterine tone during isoflurane anesthesia for cesarean section

Mohamed R. El Tahan; Osama M. Warda; Amal Rashad; Amr M. Yasseen; Eiad A. Ramzy; Mona S. Ahmady; Douaa G. Diab; Mohamed K. Matter

http://dx.doi.org/10.1590/S0034-70942012000500003 Braz J Anesthesiol, vol.62, n5, p.630-635, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: Misoprostol reduz o sangramento uterino após o parto cesáreo sem efeitos prejudiciais para a mãe ou o bebê. Nosso objetivo foi avaliar os efeitos de misoprostol pré-operatório no sangramento materno e no tônus uterino e a necessidade de ocitocina após cesariana sob anestesia com isoflurano. MÉTODOS: Depois da aprovação pelo Comitê de Ética, 366 pacientes programadas para cesariana eletiva foram randomicamente designadas para receber 400 µg de misoprostol sublingual (n = 179) ou um comprimido de placebo (n = 187) após intubação. A anestesia foi mantida com CAM de isoflurano a 0,5-0,7 e óxido nitroso. Todas as pacientes receberam infusão de ocitocina (10 UI) após expulsão da placenta. A estimativa de perda sanguínea, do tônus uterino, da necessidade de ocitocina complementar, da contagem de hematócrito, dos escores de Apgar no 1º e aos 5 minutos e os efeitos adversos foram registrados. RESULTADOS: Após a indução, as pacientes que receberam misoprostol sublingual tiveram perda sanguínea perioperatória (202 ± 383,1 vs 708 ± 204,3 mL, p < 0,001), necessidade de ocitocina (p < 0,001), níveis mais elevados de hematócrito (p < 0,001) e tônus uterino (p < 0,02) menos significativos. A incidência de tremores foi maior no grupo misoprostol (p = 0,04). Não houve diferenças entre os dois grupos quanto aos índices de Apgar, náusea e vômito, distúrbios gastrointestinais e febre. CONCLUSÃO: A administração pré-operatória de misoprostol sublingual (400 µg) é segura e eficaz para atenuar o sangramento materno e o efeito no tônus uterino da anestesia com isoflurano em parto cesário.

Palavras-chave

ANESTESIA, Obstétrica, ANESTÉSICOS, Volatil, isoflurano, CIRURGIA, Cesárea, COMPLICAÇÕES, Hemorragia, DROGAS, misoprostol

Abstract

BACKGROUND AND OBJECTIVES: Misoprostol would reduce the uterine bleeding after cesarean delivery without harmful effects on either mother or baby. We aimed to evaluate the effects of preoperative misoprostol on maternal blood loss, uterine tone, and the need for additional oxytocin after cesarean delivery under isoflurane anesthesia. METHODS: After ethical approval, 366 patients scheduled for elective cesarean delivery were randomly allocated to receive either sublingual misoprostol 400 µg (n = 179) or placebo tablet (n = 187) after intubation. Anesthesia was maintained with 0.5-0.7 MAC isoflurane with nitrous oxide. All patients received intravenous infusion of 10 IU of oxytocin after placental delivery. Perioperative estimated blood loss, uterine tone, need for supplementary oxytocin, hematocrit, Apgar scores at 1 and 5 min and adverse effects were recorded. RESULTS: After induction, patients receiving sublingual misoprostol had significant less perioperative estimated blood loss (202 ± 383.1 vs. 708 ± 204.3 mL, p < 0.001), need for oxytocin (p < 0.001), higher hematocrit levels (p < 0.001) and uterine tone (p < 0.02). The incidence of shivering was higher in the misoprostol group (p = 0.04). There were no differences between the two groups as regarding Apgar scores, nausea and vomiting, gastrointestinal disturbances and pyrexia. CONCLUSION: Preoperative administration of sublingual misoprostol 400 µg is safe and effective in attenuating the maternal bleeding and uterine atony from isoflurane anesthesia for cesarean delivery.

Keywords

Anesthesia, Obstetrical, Cesarean Section, Isoflurane, Hemorrhage, Misoprostol

References

Gambling DR, Sharma SK, White PF. Use of sevoflurane during elective cesarean birth: a comparison with isoflurane and spinal Anaesthesia. Anesth Analg. 1995;81:90-95.

Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;18.

Tsai PS, Huang CJ, Hung YC. Effects on the bispectral index during elective caesarean section: a comparison of propofol and isoflurane. Acta Anaesthesiol Sin. 2001;39:17-22.

Navarro EM. Desflurane-general Anaesthesia for cesarean section compared with isoflurane and epidural Anaesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;35:232-238.

Ohashi Y, Sumikura H, Tateda T. Inhibitory effect of alprostadil against sevoflurane-induced myometrial relaxation in rats. J Anesth. 2007;21:361-367.

Yamakage M, Tsujiguchi N, Chen X. Sevoflurane inhibits contraction of uterine smooth muscle from pregnant rats similarly to halothane and isoflurane. Can J Anesth. 2002;49:62-66.

Dogru K, Yildiz K, Dalgiç H. Inhibitory effects of desflurane and sevoflurane on contractions of isolated gravid rat myometrium under oxytocin stimulation. Acta Anaesthesiol Scand. 2003;47:472-476.

Yildiz K, Dogru K, Dalgic H. Inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated pregnant human myometrium. Acta Anaesthesiol Scand. 2005;49:1355-1364.

Yoo KY, Lee JC, Yoon MH. The effects of volatile anesthetics on spontaneous contractility of isolated human pregnant uterine muscle: a comparison among sevoflurane, desflurane, isoflurane, and halothane. Anesth Analg. 2006;103:443-450.

Dyer RA, Butwick AJ, Carvalho B. Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist. Curr Opin Anaesthesiol. 2011;24:255-261.

Owonikoko KM, Arowojolu AO, Okunlola MA. Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: a randomized controlled trial. J Obstet Gynaecol Res. 2011;37:715-721.

Chaudhuri P, Banerjee GB, Mandal A. Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss. Int J Gynaecol Obstet. 2010;109:25-34.

Fekih M, Jnifene A, Fathallah K. Benefit of misoprostol for prevention of postpartum hemorrhage in cesarean section: a randomized controlled trial. J Gynecol Obstet Biol Reprod (Paris). 2009;38:588- 593.

Eftekhari N, Doroodian M, Lashkarizadeh R. The effect of sublingual misoprostol versus intravenous oxytocin in reducing bleeding after caesarean section. J Obstet Gynaecol. 2009;29:633-639.

Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at caesarean section. Int J Gynaecol Obstet. 2006;92:106-110.

Hamm J, Russell Z, Botha T. Buccal misoprostol to prevent hemorrhage at cesarean delivery: a randomized study. Am J Obstet Gynecol. 2005;192:1404-1410.

Acharya G, Al-Sammarai MT, Patel N. A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section. Acta Obstet Gynecol Scand. 2001;80:245-250.

Tang OS, Schweer H, Seyberth HW. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17:332-338.

Lapaire O, Schneider MC, Stotz M. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet. 2006;95:2-7.

Fraser IS, Warner P, Marantos PA. Estimating menstrual blood loss in women with normal and excessive menstrual fluid volume. Obstet Gynecol. 2001;98:806-814.

Stafford I, Dildy GA, Clark SL. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199:519.e1-7.

Magann EF, Evans S, Hutchinson M. Postpartum hemorrhage after cesarean delivery: an analysis of risk factors. South Med J. 2005;98:681-686.

Chin KJ, Yeo SW. Bispectral index values at sevoflurane concentrations of 1% and 1.5% in lower segment cesarean delivery. Anesth Analg. 2004;98:1140-1144.

Aronsson A, Bygdeman M, Gemzell-Danielsson K. Effects of misoprostol on uterine contractility following different routes of administration. Hum Reprod. 2004;19:81-85.

Tang OS, Schweer H, Lee SW. Pharmacokinetics of repeated doses of misoprostol. Hum Reprod. 2009;24:1862-1871.

De la Torre S, Gilson GJ, Flores S. Is high-dose misoprostol able to lower the incidence of cesarean section?: A randomized controlled trial. J Matern Fetal Med. 2001;10:85-90.

Krause E, Malorgio S, Kuhn A. Off-label use of misoprostol for labor induction: a nation-wide survey in Switzerland. Eur J Obstet Gynecol Reprod Biol. Sep .

Shook PR, Schultz JR, Reynolds JD. Estimating blood loss for cesarean section: how accurate are we?. Anesthesiology. 2003;98(^s1).

Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006;113:919-924.

Khan FA, Khan M, Ali A. Estimation of blood loss during Caesarean section: an audit. J Pak Med Assoc. 2006;56:572-577.

Butwick A, Ting V, Ralls LA. The association between thromboelastographic parameters and total estimated blood loss in patients undergoing elective cesarean delivery. Anesth Analg. 2011;112:1041-1048.

Durocher J, Bynum J, León W. High fever following postpartum administration of sublingual misoprostol. BJOG. 2010;117:845-852.

Lyons G, MacDonald R. Awareness during caesarean section. Anaesthesia. 1991;46:62-66.

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