В основном все исследования, касающиеся эпидуральных анестезий, сравнивали один анестетик с другим, определяли, как часто применяется эпидуральная анестезия. Но, к сожалению, практически ни одно исследование не ставило себе целью определить, как воздействует эпидуральная анестезия на состояние здоровья матери и ребенка в долгосрочной перспективе. Исследования, показывающие увеличение случаев, когда необходимо делать кесарево сечение, очень малочисленны. Также недостаточно хорошо исследован вопрос: если делать эпидуральную анестезию на поздней стадии родовой деятельности, снизит ли это риск при вакуум-экстракции плода, наложении акушерских щипцов или кесаревом сечении.
Это русскоязычные издания.
Potential Risks
Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.
Undesired effects on the mother:
Inadequate pain relief (up to 10%)4
Rise of the mother's oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6
Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother's trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7
Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.
Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8
Mild to severe itching of the skin (with narcotics)
Retention of urine, requiring a bladder catheter1
Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9
Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11.
Undesired effects on the labor:
May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12
Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13
Undesired effects on the fetus:
Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an "epidural fever" that causes fetal tachycardia or newborn fever.
If the fetus is already stressed greater amounts of the medication are "trapped" in the fetal circulation, leading to more pronounced newborn effects (see below).
Undesired effects on the newborn:
Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.
Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6
Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother."
Вот риски и побочные эффекты от эпидуралки.
Тема: Эпидуральная анестезия или общий наркоз. что выбрать? (Прочитано 61920 раз)
