Epidural test dose in obstetric patients: should we still use it?
Curr Opin Anaesthesiol
; 32(3): 263-267, 2019 Jun.
Article
en En
| MEDLINE
| ID: mdl-30985339
ABSTRACT
PURPOSE OF REVIEW As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. RECENT FINDINGS:
Present guidelines do not provide clear recommendations in this regard and several recent surveys indicate a heterogeneity in clinical routine.SUMMARY:
Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Cateterismo
/
Analgesia Epidural
/
Epinefrina
/
Analgesia Obstétrica
/
Anestésicos Locales
Tipo de estudio:
Guideline
/
Qualitative_research
Límite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Año:
2019
Tipo del documento:
Article