Hemodynamic Effects of Oxytocin and Carbetocin During Elective Cesarean Section in Preeclamptic Patients Under Spinal Anesthesia: A Randomized Double-blind Controlled Study.

Background: Oxytocin and carbetocin are uterotonic medications that are used to decrease postpartum hemorrhage (PPH). However, there are not enough clinical data about the hemodynamic side effects of carbetocin. Objectives: This study aimed to compare carbetocin and oxytocin hemodynamic effects in preeclamptic patients undergoing elective cesarean section under spinal anesthesia. Methods: In this double-blind, randomized controlled trial, intravenous oxytocin or carbetocin was administered to 80 women (40 per group). The hemodynamic effects, such as blood pressure (BP), heart rate (HR), and oxygen (O2) saturation, were measured before the operation and after 1, 5, 10, and 15 minutes of the administration of both drugs. Intragroup and intergroup comparisons were conducted during statistical analysis. Results: Based on the intragroup comparison, there was a significant increase in HR and a reduction in BP from baseline to all intervals after the administration of both interventions. Moreover, based on the intergroup comparison, there was a significantly more increase in HR and a decline in BP and O2 saturation in the oxytocin group than in the carbetocin group. There were three and seven cases that required another dose of carbetocin and oxytocin, respectively. Moreover, one case developed PPH in the carbetocin group; nevertheless, two cases developed PPH in the oxytocin group. Conclusions: The minimal effect of carbetocin on patients' hemodynamics suggests extending the use of this drug instead of oxytocin as a uterotonic drug in patients with preeclampsia, hemorrhagic risk factors, and/or hypertension.

Early Postoperative Cognitive Dysfunction in Women Undergoing Elective and Emergent Caesarian Section under General Anaesthesia: A Comparative Study.

Background: Postoperative cognitive dysfunction (POCD) following cesarean section (CS) is a growing and underestimated problem with unknown mechanisms. Studies suggest that general anesthesia (GA) plays a role in the development of early POCD. Objectives: This study aimed to assess the incidence of early POCD after elective and emergent CS under GA. Methods: We assessed the difference between the elective and emergent groups regarding the mini-mental state examination (MMSE), hemodynamic effects such as mean blood pressure (MBP), and heart rate (HR). Paired t-test was applied for intragroup comparison, and Student's t-test (or Mann-Whitney U test, as appropriate) for intergroup comparison. Results: MMSE one hour after the operation was significantly lower than preoperative MMSE in the emergent group, and the MMSE tended to return to normal values faster in the elective than in the emergent group. Moreover, we found a significantly lower MBP and higher HR (at 15, 30, and 45 minutes) in both groups compared to preoperative values. Regarding intergroup comparison, MBP (at 30 minutes) significantly decreased in the elective group compared to the emergent group. Conclusions: There was a significantly lower POCD, especially at the first hour postoperatively, in the elective CS than in the emergent CS. Elective CS might have a positive effect on the women's health as a mode of delivery.