Eley V A, Callaway L K, van Zundert A A J, Lipman J, Gallois C
Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland.
Obstetric Physician, School of Medicine, The University of Queensland, Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland.
Anaesth Intensive Care. 2016 Sep;44(5):620-7. doi: 10.1177/0310057X1604400521.
Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015. Leximancer™ text analysis software applied a validated algorithm to the data to identify themes and concepts. The major themes were explored by the first author to answer the research question. Three major themes were identified: the demands associated with caring for obese women; concern regarding the anaesthetic technique used in obese women; and the importance of communication with obstetric staff. Disagreement regarding interpretation and application of early epidural analgesia was identified within this group of anaesthetists. These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients.
照顾肥胖孕妇给所有医学专业人员都带来了挑战。尽管缺乏支持性证据，但专家意见和国际指南建议为肥胖女性在分娩早期插入硬膜外导管。但据传闻，并非所有麻醉医生都支持这一做法。这项定性研究探讨了麻醉医生在肥胖产妇中实施早期硬膜外镇痛的经验，以回答研究问题：麻醉医生在肥胖产妇中应用早期硬膜外镇痛的方式是否一致？2015年2月至4月期间，对在澳大利亚昆士兰州东南部工作的42名专科麻醉医生进行了个人深度访谈。Leximancer™文本分析软件对数据应用了经过验证的算法，以识别主题和概念。第一作者探讨了主要主题以回答研究问题。确定了三个主要主题：照顾肥胖女性所带来的需求；对肥胖女性使用的麻醉技术的担忧；以及与产科工作人员沟通的重要性。在这组麻醉医生中，发现了对早期硬膜外镇痛的解释和应用存在分歧。这些麻醉医生在如何解释和应用肥胖产妇早期硬膜外镇痛方面并不一致，一些人对这种做法的有效性提出了质疑。肥胖产妇带来的不确定性、紧迫性和技术难度使这些临床医生感到焦虑，尤其是对非计划全身麻醉的预期。一致的麻醉实践可以改善肥胖产妇早期硬膜外镇痛的实施情况。
