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Oxytocin Bolus Avoidance Total Spinal — FRCA Final MCQ

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HardObstetric AnaesthesiaOxytocin Bolus Avoidance Total SpinalFRCA Final

A 35-year-old woman (ASA I, 62 kg) develops total spinal anaesthesia after an intended epidural top-up for caesarean section. She is apnoeic, unconscious, and hypotensive. After intubation and vasopressor support, what specific drug should be avoided during the emergency management?

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Correct answer: A — Oxytocin bolus

In the context of a total spinal during caesarean section, once the baby is delivered, oxytocin is required for uterine contraction. However, an IV bolus of oxytocin (e.g., Syntocinon 5 IU bolus) can cause profound hypotension, tachycardia, and cardiovascular collapse – this effect is exaggerated in a patient already haemodynamically compromised by a total spinal. Oxytocin should be given as a slow infusion (5 IU over 5-10 minutes) rather than a bolus. This is a critical safety point in obstetric anaesthesia.

Reference: OAA – 2024 – Quick Reference Handbook: Oxytocin administration; RCOG – 2016 – GTG 52 PPH prevention