Department of Anesthesia, La Paz University Hospital, Madrid, Spain -
Department of Anesthesia, La Paz University Hospital, Madrid, Spain.
Minerva Anestesiol. 2017 Nov;83(11):1207-1213. doi: 10.23736/S0375-9393.17.12082-1. Epub 2017 Jun 12.
Labor epidural failure is a challenging situation for the obstetric anesthetist, especially when associated to high risk of caesarean delivery, obesity, and difficult airway predictors. Labor epidural failure is still not standardly defined, consequently its incidence is uncertain: improving the knowledge of risk factors related to failure will increase epidural block success rate. Prolonged labors, previous history of epidural failure, and repeated top-ups needed during labor are recognized risk factors for failure. Clinical experience and the use of modern equipment (ultrasound guided blocks), as well as the choice of neuraxial technique (epidural versus combined spinal-epidural) may affect failure rate. Software-controlled infusion pumps seem to increase epidural analgesia success rate. Among non-technical skills, good communication among medical team members and parturient women is another pivotal point to achieve a satisfactory analgesia for labor. Clear algorithms should be promoted where epidural failure during labor or caesarean delivery may occur.
分娩时硬膜外阻滞失败对产科麻醉医生来说是一个具有挑战性的情况，尤其是当与剖宫产、肥胖和困难气道预测因素相关时。分娩时硬膜外阻滞失败尚未有标准定义，因此其发生率不确定：增加对与失败相关的危险因素的认识将提高硬膜外阻滞的成功率。延长的产程、先前的硬膜外阻滞失败史以及分娩过程中需要反复追加药物是失败的危险因素。临床经验和使用现代设备（超声引导下阻滞）以及选择脊神经技术（硬膜外阻滞与联合腰麻-硬膜外阻滞）可能会影响失败率。软件控制输注泵似乎可以提高硬膜外镇痛的成功率。在非技术技能中，医疗团队成员和产妇之间良好的沟通是实现分娩镇痛的另一个关键因素。应该推广明确的算法，以应对分娩时或剖宫产时可能发生的硬膜外阻滞失败。
