Anesthetics and Uterine Tone
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- All volatile anesthetics cause a dose-dependent decrease in uterine tone.
- Act on GABA1 receptors, and voltage sensitive Ca2+, and Na+ channels.
- Doses higher than 0.75 MAC causes atony.
- Before delivery in a C-section, gas is titrated to 1.0 MAC to avoid maternal awareness, but is downtitrated after delivery.
- N2O, opioids, and ketamine have minimal effect, unless used at high doses.
- Propofol instead of inhaled anesthetics may reduce bleeding according to a systematic review and meta-analysis of 4 RCTs between 1997 and 2015, however, the quality of the evidence was rated as very low.