Introducing a quick reference guide for emergency uterotonic and uterine relaxant drug use

Published Date: 23rd December 2019

Publication Authors: Veal A, Goel V

Abstract

The responsibility of administering drugs for uterine relaxation or contraction during caesarean section often falls to the anaesthetist. This can be particularly challenging for staff who are unfamiliar with these drugs or do not undertake regular obstetrics sessions. In the past, general anaesthesia for caesarean section was far more common, with uterine relaxation often achieved by an increase in volatile agent. However, with the increased use of regional anaesthesia, this has become more challenging, with several drug options available, resulting in variations in clinical practice [1]. The aim of this project was to assess current knowledge and confidence of drugs used for emergency uterine contraction/ relaxation, with the aim of producing a quick reference guide. Methods We performed data collection over a 3-day period via questionnaires distributed to anaesthetic staff. Participants were asked for their knowledge of doses, administration and confidence in the use of oxytocin, ergometrine, carboprost, terbutaline and glyceryl trinitrate (GTN) and whether they felt a guide would be useful. Questionnaires were completed anonymously and deposited in a collection box. Consultants who undertook regular obstetric sessions had greater knowledge and confidence of terbutaline (86% vs. 14% for both dose/route and 43% vs. 14% for confidence, respectively) and GTN (57% vs. 14% for both dose/route and 43% vs. 14% for confidence, respectively) than consultants who did not. All respondents felt that a guide would be useful. Discussion This project showed that knowledge and confidence in the use of uterotonics was generally good, but that there is generally less knowledge regarding the use of uterine relaxants, particularly amongst staff not undertaking a regular obstetric session. All on-call anaesthetists have the potential to be involved in emergency maternity cases and, therefore, this project demonstrates a clear need for a quick reference guide. This guide has subsequently been produced and is now available in both maternity theatres.

Veal, A; Goel, V. (2019). Introducing a quick reference guide for emergency uterotonic and uterine relaxant drug use in maternity theatres . Anaesthesia. 74 (s3), 94

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