Comparison of terbutaline and atosiban as tocolytic
agents in intrauterine repair of myelomeningocele: a
retrospective cohort study

Shirley Andrade Santosa, Fernando Souza Nani, Elaine Imaeda de Moura, Diogo Lima de Carvalho, Guilherme Jorge Mattos Miguel, Cristiane Maria Federicci Haddadb, Joaquim Edson Vieira, Victor Bunduki, Mario Henrique Burlacchini de Carvalho, Rossana Pulcineli Vieira Francisco, Daniel Dante Cardeal; Hermann dos Santos Fernandes

doi:10.1016/j.bjane.2024.844495

Original Investigation

Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study

Comparação de terbutalina e atosibana como agentes tocolíticos no reparo intrauterino de mielomeningocele: um estudo de coorte retrospectivo

Shirley Andrade Santosa, Fernando Souza Nani, Elaine Imaeda de Moura, Diogo Lima de Carvalho, Guilherme Jorge Mattos Miguel, Cristiane Maria Federicci Haddadb, Joaquim Edson Vieira, Victor Bunduki, Mario Henrique Burlacchini de Carvalho, Rossana Pulcineli Vieira Francisco, Daniel Dante Cardeal; Hermann dos Santos Fernandes

http://dx.doi.org/10.1016/j.bjane.2024.844495 Braz J Anesthesiol, vol.74, n3, 844495, 2024

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Abstract

Background

Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as b2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair.

Methods

Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery.

Results

Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 § 0.05 vs. 7.396 § 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 § 12.76 mg.dL1 vs. 13.06 § 6.35 mg.dL1 , for atosiban, p = 0.001) levels.

Conclusions

Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.

Keywords

Atosiban; Perinatology; Myelomeningocele; Terbutaline; Tocolysis

Resumo

Introdução

A mielomeningocele (MMC) é uma doença de defeito do tubo neural. O reparo pré-natal da MMC fetal é uma alternativa ao reparo pós-natal. Muitos agentes podem ser utilizados como tocolíticos durante o reparo fetal in utero, como os β2-agonistas e os antagonistas dos receptores de ocitocina, com possíveis repercussões maternas e fetais. Este estudo tem como objetivo comparar a gasometria arterial materna entre terbutalina ou atosibana, como agentes tocolíticos, durante o reparo intrauterino da MMC.

Métodos

Estudo de coorte retrospectivo. Os pacientes foram divididos em dois grupos dependendo do principal agente tocolítico utilizado durante o reparo intrauterino da MMC: atosibana (16) ou terbutalina (9). As amostras de gasometria arterial materna foram analisadas em três momentos: pós-indução (basal, antes do início da tocólise), antes da extubação e duas horas após o término da cirurgia.

Resultados

Vinte e cinco pacientes foram incluídos e avaliados. Antes da extubação, o grupo terbutalina apresentou menor pH arterial (7,347 ± 0,05 vs. 7,396 ± 0,02 para atosibana, p = 0,006) e maior lactato arterial (28,33 ± 12,76 mg.dL⁻¹ vs. 13,06 ± 6,35 mg.dL⁻¹, para atosibana, p = 0,001).

Conclusão

Os pacientes que receberam terbutalina apresentaram mais acidose e níveis mais elevados de lactato, em comparação com aqueles que receberam atosibana, durante o reparo intrauterino da MMC fetal.

Palavras-chave

Atosibano; Perinatologia; Mielomeningocele; Terbutalina; Tocólise

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Submitted date:
06/30/2023

Accepted date:
03/04/2024