• Maria Egeland Bekkenes, Morten Wang Fagerland, Ole Geir Solberg, Lars Aaberge, Olav Klingenberg, Jon Norseth, and Leiv Arne Rosseland.
• From the Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital (MEB, LAR), the Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (MEB, OK, LAR), the Oslo Centre for Biostatistics and Epidemiology, Research Support Services (MWF), the Department of Cardiology (OGS, LA), the Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway (OK), and the Vestre Viken Hospital, Department of Clinical Biochemistry, Drammen, Norway (JN).
• Eur J Anaesthesiol. 2022 Dec 1; 39 (12): 928938928-938.

BackgroundOxytocin can stimulate release of myocardial biomarkers troponin I and T, prolong QTc and induce ST-depression.ObjectiveTo explore cardiac changes after either intravenous carbetocin or oxytocin.Study DesignExploratory phase 4 randomised controlled trial.SettingObstetrics units of Oslo University Hospital, Norway between September 2015 and May 2018.ParticipantsForty healthy, singleton pregnant women aged 18 to 50 years at gestational age at least 36 weeks with a planned caesarean delivery.InterventionsParticipants were randomised to receive either oxytocin 2.5 IU or carbetocin 100 μg immediately after delivery.Main Outcome MeasuresThe primary endpoint was the assessment of troponin I within 48 h of study drug administration. Troponin I and T, and creatine kinase myocardial band assessments were measured before spinal anaesthesia (baseline), and again at 4, 10 and 24 h after delivery. QTc, ST-depression and relative increase in heart rate were recorded from start of study drug administration to 10 min after delivery. All adverse events were monitored.ResultsCompared with the carbetocin group, higher troponin I levels were observed in the oxytocin group at 4 h and 10 h after delivery. For both treatment groups, an increase from baseline in troponin I and T was most pronounced at 10 h after delivery, and it had begun to decline by 24 h. QTc increased with time after administration of both study drugs, with a mean maximum increase of 10.4 ms observed at 9 min (P   <  0.001). No statistical differences were observed in QTc ( P  = 0.13) or ST-depression ( P  = 0.11) between the treatment groups.ConclusionsOxytocin 2.5 IU and carbetocin 100 μg caused a similar increase in QTc. The trial was underpowered with regards to ST-depression and the release of myocardial biomarkers and these warrant further investigation. Data from this trial will inform a larger phase 4 trial to determine potential drug differences in troponin release.Trial RegistrationClinicalTrials.gov Identifier: NCT02528136.Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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