Article Notes
- A 40 IU oxytocin infusion over 30 minutes is uncommon practice in Australia. (This strikes me as a study used to disprove strange local obstetric dogma!)
- Investigating the benefits of a 5 IU bolus in addition to this is hardly likely to produce a significant effect, given this essentially compares 45 IU to 40 IU over ~35 minutes.
I find this study a little perplexing:
40 IU over 30 minutes is an infusion with 'bolus-like' characteristics! 1.7 IU per minute!
Far from earth-shattering, though what I find (possibly) interesting is the long delay between the last epidural dose and the (apparent) total spinal.
90 min seems like it should be well and truly long enough for any epidural bupivacaine to be absorbed – in fact, this is probably only a little shorter than the duration of said dose. It's possible that the total spinal was totally unrelated to the epidural, but that's probably wishful thinking.
Previous studies (Dadarkar, IJOA 2014) have suggested that waiting 30 min between last epidural dose and spinal is safe (audit of 115 patients in Dallas).
The take-away for me is that there's probably more patient variability than we'd like to admit.
The actual cost of both operating theatre and recovery room time in the U.S., Canada, Australia and greater Europe is likely much, much higher than figures used by the researchers. Thus even at its current high cost there is a strong economic argument to be made for using sugammadex for routine reversal.
However, the opposing point is that the economic benefit is only real if the liberated operating room time can actually be utilised for productive surgical work – this is currently unlikely in many hospitals due to inefficient and inflexible scheduling.