Pregnancy can delay gastric emptying. What impact does epidural analgesic on the stomach empty during childbirth?

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As early as 1946, Curtis Lester Mendelson described for the first time that 66 mothers had inhaled pneumonia, and advocated measures to prevent this complications after anesthesia, including strict fasting during childbirth.

However, the rise of "regional anesthesia technology" and the advancement of obstetrics anesthesia have greatly reduced the incidence of perinatal inhalation pneumonia.In the United States, the mortality rate related to misconduct is less than oneth of the million mothers. Therefore, the practice of strict fasting during childbirth has also been questioned.

At present, the United States and European guidelines are allowed to eat clear liquid during childbirth, but the guidelines in the United States are more conservative than the European guidelines, and only non -complications are allowed to produce appropriate amounts of liquid liquid to women.

Guidelines for the United States and Europe have differences in the fasting of solid food during childbirth. The European Guide recommends foods that can be consumed and digestible during childbirth, but the Guide of the American Anesthesiologist Association, obstetric anesthesia and siege medical associations are prohibited from eating during childbirth.Any solid food.

The main reason for this difference is that there is no reliable data on the stomach of solid food during childbirth. Pain caused by uterine contraction and taking opioids may affect gastric emptying.

Previous studies have found that women still have a certain stomach empty ability during childbirth, but compared with maternals who fast -fades, mothers who do not fast within the first hour after childbirth have greater gastric capacity.Since it is not suitable to eat solid food, can you eat some easy -to -digest diet before childbirth?However, so far, there have been no clinical studies to evaluate the gastrointestinal emptiness of the light diet.

Research idea

Compared with non -pregnant women and full -moon pregnant women, women who accept epidemic analgesic or abolishment of extraordinarity in the maternal diet will be reduced.

Research methods

Ultrasonic examination of gastric sinus.

Qualitative assessment

No content in the gastric sinus appears, corresponding to the state of the cavity; the low echo content of the expanded gastric sinus corresponds to the liquid.

Quantitative assessment

Measuring the maximum diameter (D1 and D2) during the contraction process.The average measurement of the gastric sinus with the average D1 and D2 for three consecutive measurements is calculated. The formula is as follows: the gastric sinus area = π × D1 × D2/4.The subjects kept half -bedroom at the time of measurement and raised to 45 °.

Perform the first stomach content ultrasound examination to ensure that it is an empty stomach."Definition of ultrasound and empty stomach" is no liquid or solid content (empty stomach) in the gastric sinus, and the cross -section area of the gastric sinus is less than 505 mm2 (pregnant women) or 340 mm2 (non -pregnant women); otherwise, the participants, the participantsNot included in research.Record the baseline value of the sinus area measured at this time.

Then incorporate the test meal (125 grams of seasoning yogurt, 120 kcal) in 5min.Endotropic analgesic delivery groups have taken the test meal 1 hour after starting the hard membrane analgesia.After the test meal was intake, 15, 60, 90, and 120min were performed for gastrointestinal ultrasound examination, and the cross -sectional area of the gastric sinus was measured.

Main ending indicator

The gastric sinus cross -sectional area and gastric empty scores measured 15min and 90min after eating.Formula: Gastrointestinal empty scores = [(90min)/gastricin area (15min) -1] × 100%. It is equivalent to a percentage of reduction of gastric sinus cross-sectional area from 15 to 90 minutes after eating.

Secondary ending indicator

After eating 15min and 60min, the gastric empty scores are measured; the semi -empty time of each group of stomach empty.The population statistics of the four groups of women (age, height, weight, and weight index, increased weight during pregnancy, the time after the last consumption of solid food, and the last time after the transparent liquid), and the delivery group and itsData-related data (tires, pregnancy, pregnancy), and new delirium (defined based on the 3min diagnostic interview evaluation of the CAM and 3D-CAM delirium evaluation table).

Show above: There are no statistical differences in the population statistical characteristics of the four groups and the fasting time of solid food. Compared with each control group, the fasting time of the light diet in the ductal gardening group of the hard membrane is obviously short (P <0.05).

Show above: Both factor difference analysis of the pain scores of the two groups of mothers, and found that the differences between the groups are statistically significant (P <0.001). At each point in time, the average pain score of the analgesic gardening group in the hard membrane without plugsIt is significantly higher than that of an extra -town analgesic delivery group, and the statistical differences gradually disappear over time (P = 0.063).

The figure above: Compared with non -pregnant women, the area of gastric tingling 15min and 60min after a full moon has a statistically significant increase in the baseline.Extra -um analgesic gastrointestinal area after meals increased by 15, 60, and 90min.The gastrointestinal area of 15, 60, 90, and 120min after meals after the meals of the downtown group is increased compared with the baseline level, and it has statistically significant significance.

The figure above: The four groups of gastric emptying scores of the four groups have significant statistical differences.Non-pregnant women, maternal women, mothers who did not use childbirth analgesia, and maternal groups using extra-hard membrane analgesia at 90min (quarter-bit pitch) were 52%(46-61), respectively (46-61), respectively (46-61)., 45%(31-56), 7%(5-10), and 31%(17-39) (P <0.0001).The maternal-extrateriolation of the epidural group is lower than the non-pregnant women’s group and the full-month pregnancy control group.

The "main discovery" of this forward -looking research is that the maternal gastric emptying delay after eating in a small amount, and the abolishment of extraordinarily of the dribers does not seem to worsen or even help the stomach empty.This is considered when allowing women to eat a small amount of food.

So how does epidural analgesic affect stomach emptiness?So far, the overall impact of extraordinarily analgesic on the stomach of the elderly women’s solid food is unclear.

Endiginal analgesic may affect the stomach emptiness through the opposite way of "two":

① The acute pain related to gastric dysfunction by relieving pain will minimize the minimum.② Due to the intake of extractive opioid drugs, gastrointestinal power reduces gastrointestinal power and delays gastric emptying.

The results of this study reminded anesthesia doctors to be cautious when eating solid food during maternal delivery.In addition, "gastric ultrasound" can be used to monitor the stomach content and guide the decision to fast or eat during childbirth.

references

Bouvet L, Schulz T, Piana F, Desgranges FP, CHASSARD D. Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Study. Anesthesio logy. 2022 APR 1; 136 (4): 542-550. Doi: 10.1097/Aln.00000000004133. Ericum in: Anesthesiology. 2022 Feb 25 ;: PMID: 35103759.

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