Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Obstetrics and Gynaecology department, Faculty of Medicine, Assiut University, Assiut, Egypt.
BMC Anesthesiol. 2022 Apr 21;22(1):112. doi: 10.1186/s12871-022-01659-9.
Abrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section.
A randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, patients scheduled for elective cesarean section were equally randomized to receive either IV HBB 20 mg in 1 ml (Hyoscine group) or the same volume of 0.9% saline (Control group), one minute after spinal anesthesia. The primary endpoint was the incidence of intraoperative bradycardia (HR < 50 beats min). Secondary endpoints included changes in mean arterial blood pressure (MAP), the incidence of Intraoperative and Postoperative nausea or vomiting (IONV & PONV), the fetal heart rate and, Apgar score.
Of the 160 subjects randomized, 80 received HBB and 80 received placebo. There was a significant reduction in the incidence of the primary endpoint of intraoperative bradycardia (HR < 50 beats min) in the Hyoscine group (0% vs 10%; OR = 0.05, 95% CI = [0.003, 0.93]; P = 0.004) compared with placebo. MAP showed an insignificant difference between groups over time. HBB significantly decreased incidences of IONV and PONV (p = 0.002 & 0.004) respectively.
In parturients undergoing cesarean section under spinal anesthesia, pretreatment with intravenous HBB was a safe measure for both the mother and the baby to reduce the risk of severe intraoperative bradycardia, but not hypotension. Furthermore, it was associated with less incidence of both IONV and PONV.
剖宫产术中脊髓麻醉时出现的心动过缓和血流动力学不稳定并不少见，被认为是术中恶心呕吐（IONV）的主要原因之一。我们假设预防性使用氢溴酸东莨菪碱（HBB）可以改善产妇剖宫产术中的血流动力学并减少 IONV。
在一家三级大学医院进行了一项随机、双盲、安慰剂对照试验，将择期行剖宫产术的患者等分为两组，分别接受 IV HBB 20mg 加 1ml（东莨菪碱组）或相同容量的 0.9%生理盐水（对照组），在脊髓麻醉后 1 分钟。主要终点是术中心动过缓（HR<50 次/分）的发生率。次要终点包括平均动脉压（MAP）的变化、术中及术后恶心或呕吐（IONV 和 PONV）的发生率、胎儿心率和 Apgar 评分。
160 名随机患者中，80 名接受 HBB，80 名接受安慰剂。东莨菪碱组术中心动过缓（HR<50 次/分）的发生率显著降低（0% vs 10%；OR=0.05，95%CI=[0.003，0.93]；P=0.004）。与安慰剂相比，MAP 组间差异无统计学意义。HBB 显著降低了 IONV 和 PONV 的发生率（p=0.002 和 0.004）。
在脊髓麻醉下行剖宫产术的产妇中，静脉注射 HBB 预处理对母婴均是安全的，可以降低严重术中心动过缓的风险，但不会导致低血压。此外，还与 IONV 和 PONV 的发生率降低相关。
