RE: Terbutaline-its use as a tocolytic

[SUllrich@att.net]

I would be interested in knowing how many programs 
utilize Terbutaline when a patient is already on MgSO4.  
That seems to be the controversial point in OB transport 
protocols. A  s.q. dose of Terbutaline does a good job 
in relaxing the uterus but as others have pointed out 
you do have an increased risk of pulmonary edema if your 
heart rate increases significantly and you have a 
dilated pulmonary bed.  I think most MD's would think 
it's safe if s.q. dosing.  Is anyone combining MgSO4 
with IV Terbutaline?  That would seem pretty risky.  If 
you do add Terbutaline do you max out your MgSO4 first 
or do you routinely run them together?   Thanks

Steve Ullrich
> Indocin cannot be used after the gestational age of 32 weeks as it may close
> the ductus arteriosus.  Ritodrine is the only tocolytic that is approved by
> the FDA for the use of tocolysis.  No one in our area still uses Ritodrine.
> The drugs of choice in our community are MgSO4 and Terbutaline.  We do also
> use indocin and nifedipine, but not as a first line.  If you look at the
> studies, none of them are proven to work, but it seems better than doing
> nothing....  MgSO4 is shown to work in the short term.
> 
> Patti Mauseth, RN
> Perinatal Transport/Outreach Coordinator
> Good Samaritan Hospital
> 408 559-2153
> 
> 
> > -----Original Message-----
> > From:	Ken Lawson-Williams [SMTP:Macgyver@FlightMedicMail.com]
> > Sent:	Friday, June 14, 2002 12:54 PM
> > To:	flightmed@flightweb.com
> > Subject:	Re: Terbutaline-its use as a tocolytic
> > 
> > In Northern and Western Canada we use MgSO4 as a short term tocolytic for
> > transport of a labouring mother (less than 4-6 cm dilation) to a tertiary
> > center for delivery. In the Eastern Ardtic they use Ritodrine (Yutopar) as
> > first line. Have also seen indocid used prior to medevac initiation. Have
> > heard of PO ventolin (salbutamol) for long term prevention of labour and
> > SQ for acute transport situations in Australia - I think it is the same
> > drug as either terbutaline or albuterol. Perhaps an Australian or a
> > pharmacist type on the list could confirm?
> > 
> > Fly Safe. 
> > Ken L-W CCEMT-P/WMT
> > 
> > "If in the last few years you haven't discarded a major opinion or 
> > acquired a new one, check your pulse. You may be dead."
> > - Gelett Burgess
> > 
> > 
> > --- ejvonmutzl@juno.com wrote:
> > >I am researching the use of Terbutaline as a tocolytic in the air medical
> > field. What are the pros and cons of using it? Is it part of your standing
> > orders? Is there another medication that you prefer over Terbutaline for
> > premature labor?
> > >
> > >Sincerely,
> > >
> > >Ed Mutzl  FP-C
> > >Native Air
> > >Mesa,AZ
> > >
> > >
> > >
> > >
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