Posts Tagged ‘labor analgesia’

Laughing Gas Making Its Way Back Into The Labor And Deliver Department

Thursday, April 21st, 2011

According to a recent article published by MSNBC, laughing gas or nitrous oxide is making its way back into labor and delivery units in American hospitals. Although laughing gas has long been used as a pain relief in various countries, including Canada and the U.K., it has lost its popularity in the U.S. Well, maybe not for much longer.

It appears that a number of hospitals are now considering making laughing gas available as a pain relief measure for women in labor. A hospital in San Francisco and another in Seattle have been using laughing gas in their labor and delivery units for a while. Hospitals like Dartmouth-Hitchcock Medical Center plan to offer laughing gas to laboring mothers in the immediate future. Dartmouth-Hitchcock’s plan is currently being reviewed by the federal government, and arrangements are presently being made for the procurement of delivery equipment for laughing gas. Vanderbilt University Medical Center may begin offering laughing gas as well later this year.

History

Laughing gas is not a new pain relief method. Its use had become very common in hospitals when Joseph Thomas Clover invented the gas-ether inhaler in 1876. Particularly, its use in the labor and delivery setting had been very common before the introduction of epidural and spinal anesthesia. Because laughing gas is unable to eliminate pain to the same degree as epidural or spinal anesthesia, it simply could not compete with the more sophisticated pain relief alternatives, which entered the marker in the 30s and 40s.

What is laughing gas?

Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula N2O. It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic effects. It is known as “laughing gas” due to the euphoric effects of inhaling it, a property that has led to its recreational use as a dissociative anesthetic.

Laughing gas as an important pain relief alternative

Although laughing gas can only take the edge off pain, it just might be an important alternative to other more conventional pain relief methods. The patient does not have to rely on an anesthesiologist to administer the gas. The patient can herself choose how much gas to administer at any time. The effects of the gas are not long-lasting. Therefore, the patient does not have to recover in a post anesthesia care unit. Importantly, there is no associated loss of sensation and motor function during the delivery process. As such, the gas does not interfere with the woman’s ability to breath and push during labor. Laughing gas is also not known to have any adverse effects on the baby in utero.

The administration of laughing gas does not require any invasive medical procedures. By contrast, consider epidural anesthesia: An epidural requires that an epidural catheter be threaded into the epidural space, which is only about 2 mm wide. Any mistake and the consequences can be catastrophic. Epidurals have been known to cause spinal cord injury secondary t0 toxicity, spinal cord infarcts, severe hypotension, paraplegia, epidural bleeding, and even death. None of these complications are associated with the use of laughing gas.

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According to Suzanne Serat, a nurse midwife at Dartmouth-Hitchcock Medical Center:

We have a number of people who don’t want to feel the pain of labor, and nitrous oxide would not be a good option for them. They really need an epidural, and that’s perfect for them. […] Then we have a number of people who are going to wait and see what happens, and when they’re in labor, decide they’d like something and then the only option for them is an epidural but they don’t need something that strong. So they would choose to use something in the middle, but we just don’t have anything in the middle.

Nitrous oxide may just prove to be that middle option for many women who prefer to give birth without the use of powerful and potentially dangerous analgesic/anesthetic agents. If you are an expectant mother, ask your obstetrician if nitrous oxide is a pain relief option that may be available to you during labor.

Image from cartoonstock.com

For more information about epidural anesthesia and epidural complications, you may want to read these posts too:

Having an epidural when you deliver your baby? 3 Questions to ask the doctor!

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Epidural Analgesia – What Should an Expectant Mother Consider? What are the risks?

Epidural Analgesia – What Should an Expectant Mother Consider? What are the risks?

Monday, November 8th, 2010

Statistics show that about 70% of women in the U.S. elect to have epidural analgesia during labor. While epidural analgesia is very effective at helping women cope with the pain of labor, it is important to have an appreciation for the possible complications associated with such medical treatment.  If you are an expectant mother, the last thing you want to do is think about the possible risks of epidural analgesia – while you are in labor.  The decision to have epidural analgesia during labor should not be a hasty, last minute decision.  The following is a survey of a number of complications associated with epidural analgesia.  It is intended to provide expectant mothers with a general understanding of the various complications associated with epidural analgesia and to encourage further inquiry.

It is important to know that epidural analgesia may cause infection (i.e., epidural abscess). An epidural abscess is a collection of pus in the epidural space.  As the abscess gets larger, it will eventually compress the spinal cord resulting in neurological deficits (e.g., numbness and/or weakness in the legs). An epidural abscess requires immediate medical intervention.

Moreover, be aware that certain patients with blot clotting disorders are at a higher risk for bleeding (i.e., epidural hematoma). Women who are on blood thinners (e.g., Lovenox) or who are otherwise hypocoagulable are at an increased risk for developing hematomas during epidural infusions. Epidural hematomas may also cause spinal cord compression leading to potential paralysis.

Because the epidural space is only a few millimeters wide, there is a risk that the needle used to gain access to the epidural space may cross into the subdural and/or subarachnoid space.  The administration of epidural anesthesia beyond the epidural space may lead to a number of very serious complications.  When epidural anesthetic agents are administered beyond the epidural space, a patient may experience low blood pressure,   difficulty breathing, loss of motor function and sensation, nausea, loss of consciousness and even cardiac arrest.   The puncture of the dura may lead to an outflow of cerebral spinal fluid into the epidural space.  When this happens, patients complain of severe headaches, which could take days or weeks to resolve.

The inadvertent administration of an excessive amount of epidural agents may cause nerve damage as well.   Anesthesiologists are very careful to select the right epidural drugs based on the patient’s medical history, comorbidities, age, height, and weight.   The key to avoiding epidural toxicity is making sure that the proper dosage of an epidural medication is administered.  In part, this involves a determination of the acceptable dosage per unit of body weight (i.e., ml/kg).  Epidural toxicity may lead to permanent loss of motor function and sensation in the lower extremities.  If you elect to have epidural analgesia, demand to be evaluated and monitored by an anesthesiologist or certified registered nurse anesthetist (CRNA) during the epidural infusion and throughout the anesthesia recovery period.

Some patients may be allergic to certain epidural agents.  Because most epidural administrations involve a cocktail of different medications (e.g., fentanyl and bupivacaine), an anesthesiologist should be familiar with the patient’s history of allergies.  If you are considering epidural analgesia, make sure that you are not allergic to “caine” drugs or opiates.

Epidural analgesia may also make it more difficult to push during labor. Consequently, the use of epidural analgesia may lead to other medical interventions, including the use of Pitocin and a Caesarean section.

If you are an expectant mother, talk to your obstetrician about the risks associated with epidural analgesia.  The decision to proceed with epidural analgesia should be a considered decision.  Your physician can avoid some, if not most, complications associated with epidural analgesia by performing a proper and thorough assessment of your risk factors and by carefully monitoring you during labor and the recovery period.

Have you or someone you know had any complication associated with an epidural? Share your story with our readers. We welcome your comments.