Frank M, Heywood A, MacLeod D M
Anaesthetic Unit, London Hospital Medical College, Whitechapel.
Anaesthesia. 1988 Jan;43(1):54-8. doi: 10.1111/j.1365-2044.1988.tb05427.x.
An investigation into practices of the epidural services in a regional sample of obstetric units was undertaken following recent reported disasters associated with epidural analgesia for labour pain. A questionnaire was completed by all 22 obstetric units in the region, which included six teaching, 14 district and two independent centres. In three units the epidural service was shared with the obstetricians. A continuous anaesthetic presence was provided in 16 of 22 units. There was considerable variation in the attendance upon epidural patients by the anaesthetists. Instructions to midwives for top-ups and subsequent care of patients followed no uniform pattern. Midwife in-service training in the initial management of serious epidural complications and in cardiopulmonary resuscitation was inconsistent. In some units, the avoidance of aortocaval compression was not emphasised in the management of serious complications such as severe maternal hypotension, total spinal blockade or cardiac arrest of the parturient. The results obtained in this survey suggest that there is a need to review the requirements in the provision of obstetric epidural services and consideration should be given to the establishment of a generally accepted standard of practice.
在近期报道了与分娩镇痛硬膜外麻醉相关的灾难事件后，对该地区部分产科单位的硬膜外服务实践进行了调查。该地区所有22个产科单位均完成了一份问卷，其中包括6个教学单位、14个地区单位和2个独立中心。在3个单位中，硬膜外服务由产科医生共同提供。22个单位中有16个单位提供持续的麻醉服务。麻醉医生对硬膜外麻醉患者的护理存在很大差异。助产士进行追加药物及后续患者护理的指导没有统一模式。助产士在严重硬膜外并发症初始处理及心肺复苏方面的在职培训不一致。在一些单位，在处理严重并发症（如严重产妇低血压、全脊髓阻滞或产妇心脏骤停）时，未强调避免主动脉腔静脉压迫。本次调查结果表明，有必要审查产科硬膜外服务的提供要求，并应考虑制定普遍接受的实践标准。
