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Do-it-yourself anesthesia.

Anesthesia during labor is a trade-off between reducing pain and protecting the newborn infant from the effects of the anesthesia. The proper balance can be delicate, given the subjective nature of pain and the anesthetist's judgment of its severity during the birth process.

The best judge of adequate pain relief is, of course, the mother--so why not let her control the amount of anesthetic? That's exactly what's being done in growing number of cases on an experimental basis. Through the use of epidural (spinal) anesthesia and a patient-controlled pump, the patient decides how much she needs as the birth process progresses.

A recent study reported in Obstetrics and Gynecology involved 84 healthy women with uncomplicated deliveries, one-third of whom received a continuous fixed amount of anesthetic from a preprogrammed pump. The other two-thirds were allowed, within limits, to control the amount of anesthetic by activating the pump when pain became too severe. The pump was programmed to deliver a fixed baseline rate of anesthetic (4 ml/hour), to which the patient could add an additional 4 ml once every 10 minutes, if desired, with a maximum of 20 ml total in one hour. (The patient pressed the control in her hand whenever she wished; the computerized pump determined whether additional anesthetic was actually injected.)

Both groups had satisfactory results. with few side effects, healthy babies, and adequate pain relief. The group that controlled its anesthesia, however used less total anesthetic, and for less time. If further studies continue to confirm, as have other studies, that patient-controlled anesthesia has few side effects and is more cost-effective, it should soon become the preferred method of anesthesia for women with uncomplicated pregnancies.
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Title Annotation:patient-controlled anesthesia during labor
Publication:Medical Update
Date:May 1, 1991
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