Epidural

Aleah Clay Honors English II Pardys Period 2 As with any research paper, one must begin with an initial statement, that may or may not change as you move throughout the research process. The initial statement for this paper is that anesthesia used during a woman's pregnancy, specifically epidural anesthesia, can affect a fetus and mother in a negative way. This was a tough topic because more than fifty percent of the sources used, all had the positive and negative aspects of anesthesia. But, they also conclusively said that most effects found can not accurately be blamed dependently on the anesthesia given. This is because of outside factors, such as genetics, things that may not be able to be diagnosed in the fetus until after birth, etc. On the other hand, there are still effects that have been directly linked to the anesthetics themselves. This paper will give you a brief and thorough overview of the changes that the body undergoes during pregnancy, positive and negative effects of anesthesia and a brief descriptions of a few studies relevant to this topic. During a woman's pregnancy, her body undergoes many changes. These changes help determine the combination of anesthetics used and help determine how much of the anesthetics is used. These factors are used by the person administering, usually an obstetrician or nurse-anesthetists, the medications. There are several cardiovascular changes that a pregnant woman's body undergoes. These changes include: an increase in intravascular fluid volume, plasma volume increases out of proportion to red cell mass, cardiac output increases, and a decrease in systemic vascular resistance. (Ting) With the increase of plasma volume comes the possibility of developing anemia. This is commonly referred to “physiological anemia of pregnancy,” in the medical world. Cardiac output is forty percent higher than pre-pregnancy levels. From what was found, in a normal pregnancy there is not an increase in blood pressure and there is a decrease in systemic vascular resistance. (Ting) Changes in the pulmonary system include: changes in the upper airway, changes in lung volume, and the rate of denitrogenation is sped up. Changes in the upper airway occur due to the engorgement of the mucosal lining by the capillaries. This causes a blockage to the nasal passage, nosebleeds are more likely to occur, and the upper airway becomes smaller. Lung volume changes during the second trimester because of an enlarging of the uterus puts pressure on the lungs and diaphragm. The pressure from the enlarged uterus displaces the two and causes residual volume to decrease by twenty percent. The rate of denitrogenation is sped up due to the combination of higher minute ventilation and decreased FRC. This also may cause a decrease in anesthetic requirements. (Ting) Due to changes in the nervous system, levels of anesthetics that would not produce unconsciousness in a non-pregnant patients, may be sufficient anesthesia in a pregnant patient. There is also a thirty-five to fifty percent decrease in dose requirements (epidural and subarachnoid anesthesia). (Ting) You will also see an increase in renal blood flow and glomerular filtration that will go back to normal during the mother's third trimester. Because of this there are no significant anesthetic considerations. (Ting) Within the hepatic system, there is a one-fourth decrease in plasma cholinesterase activity. But, this is rarely of any significance. (Ting) The gastrointestinal system is also effected. Gastric emptying is prolonged, the uterus changes the direction of the gastro esophageal junction, and reflux and esophagitis is common in pregnant woman. This increases the number of silent regurgitation incidents. Administration of opoids for labor analgesia, or pain relief, can also slow gastric emptying. The placenta allows an exchange between mother and child of important substances, such as oxygen, carbon dioxide, and waste products of metabolism, drugs, etc. (Ting) Most studies conducted about the use of anesthesia have been done on animals, primarily rats. According to Duke Medicine News and Communications, testing on humans is ethically questionable and technically difficult. But, the author never says that it is impossible and results would be closer to accurate than testing on non-human mammals. Duke Medicine and News then goes on to mention a study done in 2003 on rats and how anesthetics affected the rat pups after the were removed from their mother's womb. These rat pups were exposed to anesthetics after they were born. The results of the study showed that the rat pups had in fact been effected in a negative way. The study showed evidence of an increase in apoptosis, or programmed cell death., in the pups' developing nerve cells. Duke's most recent study, conducted on sheep, showed that there was an increase in oxygenation in the fetal brain, which is most likely due to isoflourine (one of three agents commonly used in anesthetics). The isoflourine induces reductions in oxygen metabolism along with an increase in cerebral blood flow. The researchers found no evidence of apoptosis or neurodegeneration. (Duke) But, again, these studies were done in a non-human species. It was also noted in the article that timing the exposure to an anesthetic is of utmost importance when determining how closely animal models reflect what may occur in humans. Also, the brains of different animals are subject to different results depending upon what stage of development they are in. (Duke) Another study, reported in the journal Anesthesiology 2009, examined the medical records of all children born, between 1976 and 1982, to mother's living in 5 different areas of Olmsted County, Minnesota. In table two: Peripartum Complications From Birth Certifications, four thousand seven hundred sixty-four of the studied records were from patients who were born to mother's that had not used anesthesia, but did experience complications during pregnancy and complications during labor and delivery, the same goes for the five hundred ninety-six patients born to mothers that used anesthesia. The table shows us that a higher percentage, in most of cases studied, women that used anesthesia during their pregnancy have had more complications than those that did not use them. (Wilder) There are two types of anesthesia used in labor: regular and combined spinal epidural (CSE or the “Walking Epidural”). The difference between the two is that the CSE allows you to walk around. Both types allow you to rest and allow you to remain alert. More than fifty percent of women use epidural anesthesia when they go into labor. The epidural blocks pain and nerve impulses in the lower half of the body. An epidural is a combination of an anesthetics, opoids, and narcotics. This combination decreases the need for large doses of local anesthetics. The anesthetics in combination with the opoids and narcotics can prolong the effect of the epidural. (Epidural Anesthesia) Throughout labor and delivery, the patient can expect to receive one to two liters of IV fluid (the form in which the epidural be given in). The person administering the epidural will have the patient arch her back and have her either lay on her left side or sit up. During cleaning and injection, she must remain absolutely still. The downsides of using an epidural are: there may be soreness around the injection site, a drop in blood pressure, a severe headache may be developed, labor may slow down or stop, shivering, ringing of the ears, backache, nausea, difficulty urinating, difficulty pushing, or, in rare cases, permanent nerve damage. Fetal effects include: trouble latching on to the mother's breast for feedings, they may become lethargic in the womb, trouble getting into position for delivery, respiratory depression, and a decrease in fetal heart rate. (Epidural Anesthesia) Neonatal jaundice is another effect that has been shown to be linked to the use of anesthetics. There are unclear results, but it has been shown that many babies are born drowsy because the anesthesia, given to the mother, effects them as well. Studies have also shown that there is the possibility that anesthesia can cause poor sucking reflexes in newborn babies. But, it should wear off after a few hours. Anesthetics are known to cause a decrease in fetal heart rate and it must be monitored frequently. To help prevent this, the mother must move from side to side to help speed up delivery. (eHow) “Physiology of Pregnancy and Anesthetic Consideration,” states that it is likely that anesthetics effect in decreasing maternal blood pressure that results in decreased uterine blood flow rather than direct uterine effects that results in difficulty for the fetus. It also says that epidural anesthesia has been shown not to alter uterine blood flow as long as blood pressure is maintained. Because of the transfer of anesthetic drugs, as well as any drug the mother takes, it is best to keep drug levels as low as possible so not to harm mother or child. “Epidural Anesthesia,” states that you should not be used if: you use blood thinners, have a low platelet count, are hemorrhaging or you are in shock, have an infection in the back, have a blood infection, are not at least 4 cm dilated, your epidural space can not be located, or your labor is moving too fast. Again, this information is not concrete because of outside factors. I believe I have provided you with a significant amount of information proving that though doctors are unable to accurately pin all negative effects on anesthesia, it has been proven that many side effects harm mother and fetus in a negative way. Works Cited "The Effects of Anesthesia on the Fetus | EHow.com." EHow | How To Do Just About Everything! | How To Videos & Articles. 2010. Web. 31 May 2010. . "Epidural Anesthesia : American Pregnancy Association." Promoting Pregnancy Wellness : American Pregnancy Association. 2007. Web. 31 May 2010. . News, Duke Medicine. "Common Anesthetics Appear Safe for Developing Fetal Brain." DukeHealth.org. 2010. Web. 31 May 2010. . Ting, Paul H. "Physiology of Pregnancy and Anesthetic Considerations." Anesthesiology Info: from Paul H. Ting, M.D. 2005. Web. 31 May 2010. . Wilder, Robert T. "Early Exposure to Anesthesia and Learning Disabilities in a Population-Based Birth Cohort." Anesthesiology 110.4 (2009): 796-804. PubMed Central. Web. 31 May 2010.