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ANESTESIA EPIDURAL PD KELAHIRAN
Epiduralanesthesiais an excellent way of taking away the pain of
labor and delivery. Like
most invasive medical treatments it has risks and benefits, but
it is generally safe, hassignificant advantages over general
anesthesia, and less anesthetic is needed than with
general anesthesia. An epidural causes less stress to the
cardiovascular system because there
is fewer ups and down with pain relief. There are times that an
epidural would not be
recommended such as:
patients on coagulation or platelet therapy long-term use of
aspirin or nonsteroidal anti-inflammatory drugs problems with blood
clotting hypovolemic shock abruptio placentae an infection near the
insertion site for the catheter history of headaches history of
backaches (not related to pregnancy) chronic neurologic disorders
an allergy to the pain medicines to be used a history of certain
heart conditions (talk with your anesthesiologist if you know
you
have heart disease)
not being able to understand the risks and benefits or how the
procedure is done wellenough to give informed consent
not being able to cooperate during the procedure for positioning
and insertion of theneedle
being unable to give feedback about pain levels or problems
previous spinal surgery has scarred the epidural space spinal
curvature such as scoliosis is present
It is important that you learn about those risks and benefits
before deciding if an epidural is
right for you. Although rare, infection and neurologic injury
can happen. You and your
support person should discuss risks and benefits and sign a
writtenconsent formbefore the
epidural anesthetic is given. If you do not understand the risks
and benefits or how the
procedure is done, an epidural is not for you.
What is epidural anesthesia?Epidural anesthesia uses repeated
doses of a local anesthetic in the epidural space of the
spinal area. It numbs the nerves from the uterus and birth
passage without stopping labor. A
successful epidural, once administered gives you an almost
pain-free awake state throughout
the entire labor and birth of your baby.
Most obstetricians will consider an epidural if the mother asks
for it. Epidural is often the
method of choice in cases of hypertension and premature
labor.
An epidural is administered by ananesthesiologista physician who
is a specialist in
anesthesia. Your labor is watched carefully before the medicine
is given. A specially trainedcertified nurse midwife or the
physician will be near by until your baby is born.
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How is it done?
Woman receiving an epidural (very short movie)An epidural is
usually not administered
until you are in active labor. Before the procedure begins,
intravenous (IV) fluids are started
and 1-2 liters of fluids are given. The IVs will continue
throughout labor and birth. Then, you
will be asked to position yourself lying down your left side
with your chin on your chest and
you knees close to your abdomen or in a sitting position with
your head down, your shoulders
slumped and your arms out in frontthis bends the vertebrae and
shows bony landmarks and
opens up the vertebral spaces. The sitting position is preferred
because it lets the
anesthesiologist see anatomic landmarks more easily and keeps
the spinal cord straight. The
waistline area of your mid back is wiped with an antiseptic
solution to reduce the skin
bacteria and lessen the chance of infection. A coin-sized area
of skin on your back is numbed
with an injectable local anesthetic. You need to be as still as
possible while a larger needle is
placed through the numbed area and into the epidural space of
your spine. A small tube
(catheter) is threaded into that needle, until the tip reaches
the epidural space around the
spinal cord. Then, the needle is removed carefully, leaving the
catheter in place. A test doseof medicine is injected into the
catheter to confirm the proper placement of the catheter. The
test dose of medicine speeds up your heart rate if the needle is
in the wrong place. If your
heart rate stays the same, the placement is correct and the
first dose of pain medicine is given.
The catheter is then taped in place to the skin on your back so
more medicine can easily be
injected later. Once in place, the catheter does not restrict
moving side to side in bed and it
can not felt in the back. The pain involved during the
administration procedure may be a
slight pinch or it may be painful for several minutes.
The pain medicine diffuses into the spinal cord and nerve roots
that branch out from the
spine. The pain medicine blocks the nerve impulses before they
reach the brain. If a steroid is
used it reduces inflammation.
Three to five minutes after the first dose, the nerves of the
uterus begin to numb. After ten
minutes you will feel the full effect and you should have
complete freedom from pain. As the
first dose of anesthesia begins to wear off, another dose can be
given through the catheter
before contractions become uncomfortable. Another dose of
medicine will be given every
one to two hours depending on the specific anesthetic drug(s)
and the amount and strength of
the medicine given.
As soon as the baby is born, the catheter is removed. The effect
of the anesthesia usually
wears off completely in one or two hours. At that time, you may
experience an uncomfortable
burning sensation around the birth canal.
Are epidurals safe?
At this time, epidurals are thought to be safe for both mother
and baby. However, there are
risks, and limited studies have been done. Epidurals may require
other medical procedures
(such as forceps), which add to the risk. The most common side
effect is a sudden drop in the
womans blood pressure. This problem occurs 1 to 2 percent of the
time and can be
dangerous to a woman and baby. When it happens, the medical
staff is there to take quick
action. Usually, they can correct the problem. Frequent blood
pressure monitoring, with
either a machine or by a staff member, is required after each
dose of medicine. Some women
http://healthpages.org/wp-content/uploads/2010/07/epidural.movhttp://healthpages.org/wp-content/uploads/2010/07/epidural.movhttp://healthpages.org/wp-content/uploads/2010/07/epidural.mov
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find this comforting, while others find the monitoring
irritating, because it disturbs the
interaction with their support people.
Other complications:
Infection Needle is inserted into the wrong space and the
epidural doesnt relieve pain Loss of tone in the bladder which can
require a catheterization (about 40% of the
time)
Total spinal block can happen if the anesthetic is injected into
the cerebrospinal space.Breathing is paralyzed and a drop in blood
pressure. This is an emergency.
Do epidurals always work?
If the physician cannot easily locate the epidural space, it may
not be possible to use epidural
pain relief. This seldom happens. Sometimes labor begins so fast
that there is not enough
time to use an epidural. Some epidurals give patchy anesthesia,
causing the feeling that
some parts of the abdomen are numb and other parts are not.
Can anyone have an epidural?
Most women can have an epidural, although women who have had
back surgery, heart or
blood disorders and those who have an allergy to -caine medicine
should discuss those
problems with their physicians and anesthesiologists.
Advantages of Epidural Anesthesia
Freedom from more pain during labor, birth and anepisiotomyif
you need it. Unlike some other drugs, it does not make the mother
drowsy before or after delivery. Limited amount of medicine reaches
the baby. Close monitoring by the hospital staff may give the
laboring mother a sense of
confidence.
Disadvantages of Epidural Anesthesia
The second stage of labor may be slowed down by the mothers
inability to moveabout and make use of gravity.
The mother must stay in bed on her side with her head at the
same level throughoutlabor.
The mother must have constant intravenous fluids and electronic
fetal monitoring. The mother must have her blood pressure taken
often. The mother will probably need a urinary catheter, which has
its own risks. The baby may be delivered by forceps, which has
risks.
http://healthpages.org/surgical-care/episiotomy/http://healthpages.org/surgical-care/episiotomy/http://healthpages.org/surgical-care/episiotomy/http://healthpages.org/surgical-care/episiotomy/
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The mother has little control over her body and may not feel the
birth process. Thiscan interfere with maternal-infant bonding.
The mother must depend totally on nurses, certified nurse
midwives and doctors forbasic physical needs.
Extremely rare, but serious medical risks exist, about which the
mother and herpartner must be aware.
What can be used instead of an epidural for pain relief?
There are other ways of reducing the pain of labor. Many women
are helped by techniques
learned in childbirth classesrelaxation, massage, positioning,
visualization, distraction,
focusing and breathing that are done with the support of another
person. These non-drug
coping skills use your own strengths and place you in control of
your own body.
Epidural anesthesia is one method that can give relief from pain
and discomfort in labor. It
does require that you give some control to the hospital staff.
It does involve risks. The final
decision is yours. Understanding this procedure can help you
decide what is right for you.
tags:episiotomy complications
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