Re: Epidurál - ANO !! Epidurál - NE!!

Je videt pane Valento, ze si velmi brojite epidural a proto vzdy budete hajit, ze je to velmi bezpecny dar z nebe, ktery nema zadne vedlejsi neblahe ucinky.
Tak znovu - tohle je clanek pouze 4 roky stary, takze zadny ze zastaralych knih, jestli chcete, najdu vam i novejsi - ale moc se nelisi - a tady vam to vysvetli snad lepe nez ja. S radosti si dovoluji prelozit:

All About Epidurals

by Sarah Buckley, Brisbane, Australia.
Nov 1998


Epidural pain relief is an increasingly popular choice for Australian women in the labour ward. Up to one-third of all birthing women have an epidural, and it is especially common amongst women having their first babies. For women giving birth by caesarean section, epidurals are
certainly a great alternative to general anaesthetic, allowing women to see their baby being born, and to hold and breastfeed at an early stage: however their use as a part of a normal vaginal birth is more questionable

(Epidural je cim dal tim vice popularni prostredek k uleve od bolesti pouzivany rodickami v Australii. Az jedna tretina techto rodicek puzije epidural a vetsinou jsou to prvorodicky. Pro zeny rodici cisarskym rezem je epidural bezpochyb lepsi alternativou nez celkove umrtveni a dovoluje jim videt jejich dite hned po narozeni, drzet je a kojit hned jak je to mozne, ale uziti epiduralu pri vaginalnim porodu sebou nese vice otazek....

There are several types of epidural used in Australian hospitals. In a conventional epidural, a dose of local anaesthetic is injected through the lower back into the epidural space, around the spinal cord. This numbs the nerves which bring sensation from the uterus and birth canal.
Unfortunately, the local anaesthetic also numbs the nerves which control the pelvic muscles and legs, so with this type of epidural, a woman usually cannot move her legs and, unless the epidural has worn off, cannot push her baby out, in the second stage of labour.

Existuje nekolik druhu epiduralu, ktere se pouzivaji v Australskych porodinicich. Pri tradicnim epiduralu je anestetikum zavedeno injekci v miste zad do epiduralniho mista, ktere je v oblasti michy. Toto znecitlivy nervy, ktere kontroluji svaly panevniho dna a noh, takze s timto druhem epiduralu zeny vetsinou nemohou hybat nohama, pokud ovsem tento epidural neodeznel a taky nemohou dite vytlacit v druhe dobe porodni.

More recent forms of epidurals use a lower dose of local anaesthetic, usually combined with an opiate, such as pethidine, morphine or fentanyl (sublimaze). With this low-dose or combination epidural, most women can
move around with support; however the chance of a woman being able to give birth without forceps is still low. Another form of epidural, popular in the US, is the CSE, or combined spinal-epiudural, where a one-off dose of opiate, with or without local anaesthetic, is injected into the spinal space, very close to the end of the spinal cord. This gives pain relief for
around 2 hours, and if further pain relief is needed, it is given as an epidural. These forms of "walking epidural" may seem advantageous, but being attached to a CTG machine to monitor the baby, and hooked up to a drip which is also a requirement when an epidural is in place, can make
walking impossible.

Dnes je velmi oblibena varianta, kdy se zavede mensi davka anestetika, vetsinou zkombinovana s nejakym dalsim opiatem. S timto druhem epiduralu se mnoho zen muze s pomoci pohybovat; ovsem sance, ze rodicka bude moci porodit bez pomoci klesti je stale miziva. Dalsi forma epiduralu, velmi popularni v US je CSE tkzv. kombinovany spinalni epidural, kdy se zavede pouze jedna davka opiatu s nebo bez localniho umrtveni do oblasti spinalni velmi blizko michy. Toto nabizi ulevu od bolesti po dobu 2 hodin a pokud je potreba dalsiho pouziti prostredku tlumicich bolest, zavede se epidural. Tato forma "chodiciho epiduralu" ma sve vyhody, ale znamena to taky, ze rodicka bude pripojena na monitor, bude zavedena kapacka, ktera se zavadi vzdy pokud je zaveden epidural a takto je chozeni taktez omezeno.

Many women have a good experience with epidurals. Sometimes the relief from pain can allow a woman to rest and relax sufficiently to go on and have a good birth experience. However deciding to use an epidural for pain relief can also lead to a "cascade of intervention", where an otherwise normal
birth becomes highly medicalised, and a woman feels that she loses her control and autonomy. Often the decision to accept an epidural is made without an awareness of these, and other, significant risks to both mother and baby.

Mnoho zen ma na epidural jen dobre vzpominky. Nekdy ta uleva od bolesti, kterou epidural nabizi, pomuze rodickam relaxovat natolik, aby nabraly dostatek sil a mely hezky zazitek z porodu. Bohuzel rozhodnuti pouzit epidural vede k spouste dalsich zbytecnych zasahu, diky kterym jinak spontanni porod se stane vysoce medikalnim a zena se muze citit, ze nad svym telem ztraci kontrolu. V mnoha pripadech se zena rozhodne pro epidural, prestoze neni obeznamena s riziky s epiduralem spojene jak pro ni tak pro dite.

Although the drugs used in epidurals are injected around the spinal cord, substantial amounts enter the mothers blood stream, and pass through the placenta into the baby"s circulation. Most of the side effects of epidurals are due to these "systemic", or whole-body effects.

Prestoze drogy, ktere epidural obsahuji, jsou podavany okolo patere, tak se dostane dost velka cast do krevniho obehu rodicky a placentou rovnou k diteti. Vetsina vedlejsich ucinku epiduralu je diky temto systematickym, nebo chcete-li celkovym efektum tela.

One of the most commonly recognised side effects is a drop in blood pressure. Up to one woman in eight will have this side effect to some degree, and for this reason, extra fluids are usually given through a drip to prevent problems. A drop in the mother"s blood pressure will affect how much of her blood is pumped to the placenta, and can lead to less oxygen
being available to the baby.

Jednim z nejvice vedlejsich ucinku spojenych s epiduralem je snizeni krevniho tlaku. Az jedna z osmi zen bude timti trpet a z tohoto duvodu se zvysi prijem tekutin skrz kapacku, aby se predeslo problemum. Snizeni krevniho tlaku ovlivni kolik krve je pumpovano do placenty a toto muze vest k omezenemu privodu kysliku k diteti.

An epidural will often slow a woman"s labour, and she is three times more likely to be given an oxytocin drip to speed things up. The second stage of labour is particularly slowed, leading to a three times increased chance of forceps. Women having their first baby are particularly affected;
choosing an epidural can reduce their chance of a normal delivery to less than 50%.

Epidural vetsinou zpomali porodni proces, proto ma 3x vetsi sanci, ze bude potrebovat oxitocin, aby se kontrakce znovu rozbehly. Nejvice se zpomali druha doba porodni a to vede k 3x vetsi sanci pouziti klesti. Prvorodicky jsou timto postizeny nejvice; vyber epiduralu pro ne muze znamenat snizeni sance spontanniho porodu o vice nez 50%.


This slowing of labour is at least partly related to the effect of the epidural on a woman"s pelvic floor muscles. These muscles guide the baby"s head so that it enters the birth canal in the best position. When these muscles are not working, dystocia, or poor progress, may result, leading to the need for high forceps to turn the baby, or a caesarean section. Having
an epidural doubles a woman"s chance of having a caesarean section for dystocia.

Zpomaleni kontrakci je z casti zavineno ztratou citlivosti svalu panevniho dna. Tyto svaly naviguji hlavicku tak, aby zaujala pro porod nejuspesnejsi pozici. Kdyz tyto svaly nepracuji, nastane dystocie, neboli velmi maly progres a je nutno pouziti klesti k otoceni ditete do vhodne polohy nebo pouziti cisarskeho rezu. Pouziti epiduralu zvysuje sanci rodicek, ze porod bude ukoncen operativne 2x diky dystocii.

When forceps are used, or if there is a concern that the second stage is too long, a woman may be given an episiotomy, where the perineum, or tissues between the vaginal entrance and anus, are cut to enlarge the outlet and hurry the birth. Stitches are needed and it may be painful to
sit until the episiotomy has healed, in 2 to 4 weeks.

Pokud se pouzivaji kleste a je duvod k obavam, ze druha doba porodni trva prilis dlouho, tak se provede nastrizeni, aby se vse uspisilo. Stehy jsou potreba a stehy mohou byt velmi bolestive 2 - 4 tydny po porodu.

As well as numbing the uterus, an epidural will numb the bladder, and a woman may not be able to pass urine, in which case she will be catheterised. This involves a tube being passed up from the urethrer to drain the bladder, which can feel uncomfortable or embarrassing.

Tak jako epidural znecitlivy delohu tak znecitlivi i mocovy mechyr. Je tedy treba cevkovat. O problemech spojenych s cevkovanim jsem uz psala.

Other side effects of epidurals vary a little depending on the particular drugs used. Pruritis, or generalized itching of the skin, is common when opiate drugs are given. It may be more or less intense and affects at least 1/4 of women: morphine or diamorphine are most likely to cause this.
Morphine also causes oral herpes in 15% of women.

Dalsi vedlejsi ucinky epiduralu se lisi podle toho, jake drogy byly pouzity. Pruritis, neboli svedeni kuze je velmi caste, pokud byly pouzity opiatove drogy. Svedeni muze byt velmi intenzivni a ovlivni 1/4 zen: toto zpusobi vetsinou morphine nebo diamorphine. Morphine take zpusobuje ustni afty 15% zen.

All opiate drugs can cause nausea and vomiting, although this is less likely with an epidural around 30% than when these drugs are given into the muscle or bloodstream, where larger doses are needed. Up to 1/3 of women with an epidural will experience shivering, which is related to effects on the bodies heat-regulating system.

Vsechny opiaty zpusobuji nevolnost a zvraceni, ikdyz tohle je diky epiduralu riziko mensi, nez kdyz jsou zavedeny injekci primo do svalu nebo zily, protoze v takovych pripadech je treba vetsi davky. Az 1/3 zen, ktere dsostanou epidural dostane zimnici, protoze je ovlivnen system regulujici teplotu tela.

When an epidural has been in place for more than 5 hours, a woman"s body temperature may begin to rise. This will lead to an increase in both her own and her baby"s heart rate, which is detectable on the CTG monitor. Fetal tachycardia, or fast heart rate can be a sign of distress, and the elevated temperature can also be a sign of infection such as
chorioamnionitis, which affects the uterus and baby. This can lead to such interventions as caesarean section for possible distress or infection, or, at the least, investigations of the baby after birth such as blood and spinal fluid samples, and several days of separation, observation, and possibly antibiotics, until the results are available.

Pokud byl epidural zaveden po vice nez 5 hodin, teplota tela rodicky se zacne zvysovat. Toto zpusobi zvyseni tepu jak jejiho tak i ditete, ktere je mozne zaznamenat na monitoru. Fetal tachycardia, neboli prilis rychly tlukot srdicka muze byt znamka ze se diteti nedari a zvysena teplota muze byt znamkou infekce jako je chorioamnionitis, ktera ovlivni delohu a dite. Toto vede k cisarskemu rezu, ktery se provadi pri podezreni na infekci, zhorseni stavu ditete a vetsinou po porodu se dite odnasi na testy, kdy se mu odebira krev, spinalni tekutina a nechava se oddeleno od matky nekolik dnu na pozorovani, dokud nejsou dostupne vysledky.

Less common side effects for a woman having an epidural are; accidental puncture of the dura, or spinal cord coverings, which can cause a prolonged and sometimes severe headache (1 in 100) ongoing numb patches, which usually clear after 3 months(1 in 550); and weakness and loss of
sensation in the areas affected by the epidural, (4-18 in 10,000) also usually resolving by 3 months.

Mene zname vedlejsi ucinky epiduraly jsou: nechtene poraneni dury, coz je ochranny spinalni obal a toto zpusobuje velike trvajici bolesti hlavy (1 ze 100) trvajici znecitliveni casti tela, ktere vymizi do 3 mesicu (1 z 550); slabota nebo ztrata citlivosti v oblastech spojenych s epiduralem, ktere se vesinou spravi behem 3 mesicu (4-18 ze 10 000).

More serious but rare side effects include permanent nerve damage; convulsions and heart and breathing difficulties (1 in 20,000) and death attributable to epidural. (1 in 200,000) When opiates are used, a woman may experience difficulty in breathing which comes on 6 to 12 hours later.

Horsi dusledky a velmi nizke riziko obnasi dozivotni poraneni nervoveho systemu; srdecni nebo dychaci problemy (1 v 20 000) a taky smrt.(1 v 200 000)v techto pripadech kdy se pozily opiaty zena zakusi dychaci potize, ktere se dostavi do 6 a 12 hodin.

There is a noticeable lack of research and information about the effects of epidurals on babies. Drugs used in epidurals can reach levels at least as high as those in the mother, and because of the baby"s immature liver, these drugs take a long time- sometimes days- to be cleared from the baby"s
body. Athough findings are not consistent, possible problems, such as rapid breathing in the first few hours and vulnerability to low blood sugar suggest that these drugs have measurable effects on the newborn baby.

Co se tyka nasledku na dite, tak bohuzel chybi dostatecna studie a dostatek informaci. Drogy pozite v epiduralu se dostavaji do jater miminka a tyto drogy v tele setrvavaji po dlouhou dobu - az dnu - dokud se jich telo nezbavi. Ikdyz dukazy se stale hledaji, tak dalsi mozny nasledek na dite je zrychlene dychani v prvnich chvilich po narozeni a snizena obranyschopnost organismu pri snizene hladine cukru v krvi navrhuje, ze tyto drogy maji neblahy ucinek na nenarozene dite.


As well as these effects, babies can suffer from the interventions associated with epidural use; for example babies born by caesarean section have a higher risk of breathing difficulties.When monitoring of the heart rate by CTG is difficult, babies may have a small electrode screwed into their scalp, which may not only be unpleasant, but occasionally can
lead to infection.

Dale novorozenata mohou trpet nasledky epiduralu jako je cisarsky rez; napr. u deti narozenych cisarskym rezem se zvysuje riziko dychacich potizi. Pokud monitorovani ditete v prubehu kontrakci neni mozne, zavadi se mala elektroda, ktera se pripevni k hlavicce ditete, ktera nekdy zpusobuje infekci.

There are also suggestions that babies born after epidurals may have difficulties with breastfeeding which may be a drug effect, or may relate to more subtle changes. Studies suggest that epidurals interfere with the release of oxytocin which, as well as causing the let-down
effect in breastfeeding, encourages bonding between a mother and her young.

Taky bylo navrhnuto, ze miminka narozeny po pouziti epiduralu mohou mit potize pri kojeni diky nasledkum drog. Studie dokazuji, ze epidural komplikuje prirozene uvolneni oxitocinu, ktery zpusobuje uvolneni mleka a podporuje pouto mezi matkou a ditetem hned po narozeni.

Epidural research, much of it conducted by the anaesthetists who administer epidurals, has unfortunately focussed more on the pro"s and con"s of different drug combinations than on possible serious side-effects. There have been, for example, no rigorous studies showing whether epidurals affect the successful establishment of breastfeeding.

Studie delany anesteziology, kteri epidural provadi se bohuzel soustredi pouze na pro a proti ruznych kombinaci drog. Zatim chybi podrobna studie o tom, jestli epidural opravdu ovlivnuje kojeni.

Several studies have found subtle but definite changes in the behaviour of newborn babies after epidural with one study showing that behavioural abnormalities persisted for at least six weeks. Other studies have shown that, after an epidural, mothers spent less time with their newborn babies, and described their babies at one month as more
difficult to care for.

Studie ktere na toto tema provedeny byly ukazuji velke zmeny v chovani kojencu, ktere pretrvavaly po dobu 6 tydnu. Dalsi studie poukazuji na to, ze matky, ktere epidural mely stravi mnohem mene casu se svymi kojenci, protoze pro ne bylo velmi tezke navazat vztah, diky vykyvum chovani kojence.

While an epidural is certainly the most effective form of pain relief available, it is worth considering that ultimate satisfaction with the experience of giving birth may not be related to lack of pain.

Bez rozporu je epidural nejefektivnejsim prostredkem k uleve od bolesti, ktery je v dnesni dobe dostupny, ale stoji za to zvazit zda opravdu stoji za to.

Tak pane Valento, sice je to makacka vsechno takto prekladat, ale pokud chcete, samozrejme vam mohu napsat vice.
Hezky den