Wpływ terapii tokolitycznej na postępowanie anestezjologiczne

*Elżbieta Nowacka, Swietłana Krzemień-Wiczyńska

Summary
Spontaneous preterm labour is responsible for more than half of preterm births. Obstetric management is aimed at the early use of tocolytic drugs and corticosteroids. Because of the risk of foetal distress and/or bleeding, caesarean sections are likely to be performed more frequently than in the term pregnancies, and anaesthesiologists will frequently encounter patients receiving tocolytic drugs.
The beta-mimetics are the most common tocolytic drugs, but have significant maternal side effects like tachycardia, hypotonia, and fluid retention. Intracellular hyperkalemia can produce serious cardiac arrhythmias, especially when suxamethonium is used. Beta-mimetic drugs can also produce foetal tachycardia and cardiomyopathy.
Magnesium sulphate has been traditionally used for tocolysis, although its exact mechanism of action is not known. Administration of large doses, used in the prevention of spontaneous preterm labour, is associated with headaches, nausea, vomiting, sedation, and muscle weakness. Magnesium sulphate acts synergistically with muscle relaxants and may also enhance respiratory distress in newborns.
Calcium channel blockers are the second-line tocolytic drugs. Hypotonia during spinal anaesthesia in patients receiving these drugs is difficult to correct and may require large doses of vasoactive drugs.
Non-steroidal anti-inflammatory drugs (mainly indomethacin) have severe maternal and foetal side effects, including nausea, vomiting, gastrointestinal bleeding, and premature closure of the ductus arteriosus.
Tocolytic drugs should be used carefully and never as combined therapy. Anaesthesiologists should be aware of potential side effects, usually cardiovascular. Hypotension, frequently occurring in emergency cases, may require vigorous fluid resuscitation and large doses of vasoactive drugs.

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