臨床婦人科産科76巻12号

2022年12月発行

今月の臨床 帝王切開分娩のすべて―この1冊でわかるNew Normal Standard

術前・術中管理

術中・術後の子宮収縮薬の投与方法

著者： 日向俊輔¹

所属機関： ¹北里大学病院周産母子成育医療センター産科麻酔部門

ページ範囲：P.1239 - P.1245

文献概要

●子宮収縮薬には副作用も多く，漫然と投与せず過不足ない適正な量の投与に努める．

●子宮収縮薬の適正使用に関する国際的コンセンサスステートメントを活用する．

●弛緩出血が持続する場合には，「産科危機的出血への対応指針2022」に沿って集学的治療を行う．

参考文献

1）妊産婦死亡症例検討評価委員会，他 : 母体安全への提言2020，vol.11．2021年9月　https://www.jaog.or.jp/wp/wp-content/uploads/2021/04/botai_2020.pdf（2022年7月17日に閲覧）

2）Jennifer M, et al : Antepartum and postpartum hemorrhage. Chestnut DH, et al（eds） : Chestnut's Obstetric Anesthesia : Principles and Practice, 6th ed. pp 908-911, Elsevier Health Sciences, Amsterdam, 2019

3）Heesen M, et al : International consensus statement on the use of uterotonic agents during caesarean section. Anaesthesia 74 : 1305-1319, 2019

4）Sam Mesiano S, et al : Chapter 42- Parturition. Plant TM, et al（eds） : Knobil and Neill's Physiology of Reproduction, 4th Edition. pp1875-1925, Academic Press, 2015

5）Arrowsmith S : Oxytocin and vasopressin signalling and myometrial contraction. Curr Opin Physiol 13 : 62-70, 2020

6）Vallera C, et al : Uterotonic medications : oxytocin, methylergonovine, carboprost, misoprostol. Anesthesiol Clin 35 : 207-219, 2017

7）Butwick AJ, et al : Second-line uterotonics and the risk of hemorrhage-related morbidity. Am J Obstet Gynecol 212 : 642.e1-642.e7, 2015

8）Tunçalp O, et al : World Health Organization. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet 123 : 254-256, 2013

9）Archer TL, et al : The hemodynamics of oxytocin and other vasoactive agents during neuraxial anesthesia for cesarean delivery : findings in six cases. Int J Obstet Anesth 17 : 247-254, 2008

10）Sartain JB, et al : Intravenous oxytocin bolus of 2 units is superior to 5 units during elective Caesarean section. Br J Anaesth 101 : 822-826, 2008

11）Jonsson M, et al : ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial. BJOG 117 : 76-83, 2010

12）Carvalho JC, et al : Oxytocin requirements at elective cesarean delivery : a dose-finding study. Obstet Gynecol 104 : 1005-1010, 2004

13）George RB, et al : Up-down determination of the ED90 of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing cesarean delivery. Can J Anaesth 57 : 578-582, 2010

14）Balki M, et al : Oxytocin pretreatment attenuates oxytocin-induced contractions in human myometrium in vitro. Anesthesiology 119 : 552-561, 2013

15）Lavoie A, et al : The ED90 of prophylactic oxytocin infusion after delivery of the placenta during cesarean delivery in laboring compared with nonlaboring women : an up-down sequential allocation dose-response study. Anesth Analg 121 : 159-164, 2015

16）Butwick AJ, et al : Minimum effective bolus dose of oxytocin during elective Caesarean delivery. Br J Anaesth 104 : 338-343, 2010

17）Dennehy KC, et al : Oxytocin injection after caesarean delivery : intravenous or intramyometrial? Can J Anaesth 45 : 635-639, 1998

18）Akinaga C, et al : Randomized double-blind comparison of the effects of intramyometrial and intravenous oxytocin during elective cesarean section. J Obstet Gynaecol Res 42 : 404-409, 2016

19）日本産科婦人科学会，他 : 産科危機的出血への対応指針2022．2022年1月（改訂）　https://www.jsog.or.jp/activity/pdf/shusanki_taioushishin2022.pdf（2022年7月17日閲覧）

20）Yoo KY, et al : The effects of volatile anesthetics on spontaneous contractility of isolated human pregnant uterine muscle : a comparison among sevoflurane, desflurane, isoflurane, and halothane. Anesth Analg 103 : 443-447, 2006

21）Tsujiguchi N, et al : Mechanisms of direct inhibitory action of propofol on uterine smooth muscle contraction in pregnant rats. Anesthesiology 95 : 1245-1255, 2001

22）Kimizuka M, et al : Effects of anesthetic agents on contractions of the pregnant rat myometrium in vivo and in vitro. J Anesth 35 : 68-80, 2021

23）Tsai PS, et al : Effects on the bispectral index during elective caesarean section : a comparison of propofol and isoflurane. Acta Anaesthesiol Sin 39 : 17-22, 2001