tisdag 29 juli 2014

Läs"Medical Risks of Epidural Anesthesia During Childbirth" - "By Lewis Mehl-Madrona, M.D., Ph.D. and Morgaine Mehl-Madrona"


"Lewis E. Mehl-Madrona, M.D., Ph.D.
Associate Professor of Family Medicine and Psychiatry
Department of Family Medicine
University of Saskatchewan College of Medicine"
Articles on Epidurals




"The Medical Risks of Epidural Anesthesia (Epidurals)"


"Permanent Disability from Epidural Anesthesia

a. A disabling condition called spinal arachnoiditis can develop after epidural anesthesia. Of 6 such women, 3 were permanently confined to a wheelchair three years after their initial evaluation.66 None of these patients had any prior spinal surgery or trauma or problems with the spinal cord including previous hemorrhage, infections or other known causes of arachnoiditis. They had no neurological symptoms prior to epidural anesthesia."


"b. Paralysis can occur.68"
Neuropathy is a condition in which sensory changes occur (loss of sensation or hypersensitivity to sensation) with or without chronic pain."
"Neuropathy occurs after epidural anesthesia. It can occur from thrombosis of an artery from trauma from the epidural injection or from the catheter. A lack of adequate blood flow (and therefore oxygen) is called ischemia. This can cause neuropathy also.75"
Adverse reactions in the parturient, fetus and neonate involve alternations of the central nervous system, peripheral vascular tone and cardiac function....
Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid."


"13. Accidental Spinal Anesthesia:

When an epidural accidentally turns into a spinal anesthetic, many complications can occur:

  1. Postspinal headaches.
  2. Dysfunction of the bladder is frequent
  3. Occasionally numbness and tingling (paresthesias) of the lower limbs and abdomen develop, and sometimes there is a temporary loss or diminution of sensation in these areas.
  4. Unilateral footdrop (paralysis of the muscle that lifts the foot) has occurred.
  5. Permanent nerve damage (conditions called chronic, progressive adhesive arachnoiditis or transverse myelitis) can occur. These lead to paralysis of the lower parts of the body.
  6. Deaths have been reported.
  7. Difficult breathing
  8. Increased incidence of forceps deliveries.
The reliability of spinal anesthesia with 5% hyperbaric lignocaine was studied among 30 patients undergoing elective Cesarean. Twelve patients had hypotension and four developed severe postspinal headaches. The block progressed to the C2 dermatome in four patients and was associated with dysphagia. This was totally unpredicted and was thought due to altered cerebrospinal fluid dynamics in late pregnancy.35"



"20. Other Neurological Disabilties:


Other neurological disabilities (including a condition called Horners syndrome) can develop along with hoarseness (from even just one dose of epidural anesthetic).45 Clayton46 reported an incidence of Horner's syndrome during epidural anesthesia for elective Caesarean section of 4%. The incidence of Horner's syndrome with epidural anesthesia for vaginal delivery was 1.33%. They found it impossible to predict which patients would develop a Horner's syndrome. Even the nerves to the face can be blocked, sometimes temporarily, sometimes permanently.47 Tremors and shakes can occur.48 49
Paresthesias (persistent tingling from sensory nerves) occurred in 0.16% of patients in one study (1.6 per 1000) with an incidence of persistent neuropathy of 0.04% (4 per 10,000).50 Four of these patients had a neuropathy which eventually resolved. In another study 3.0% of patients had tingling of the hands or fingers, while 26 of almost 5000 women had persistent tingling or numbness in the lower back, buttocks or legs.51
Dizziness and fainting can become a problem after epidurals. One study found these symptoms persisting in 2.1% of women.52"





"Permanent Disability from Epidural Anesthesia

a. A disabling condition called spinal arachnoiditis can develop after epidural anesthesia. Of 6 such women, 3 were permanently confined to a wheelchair three years after their initial evaluation.66 None of these patients had any prior spinal surgery or trauma or problems with the spinal cord including previous hemorrhage, infections or other known causes of arachnoiditis. They had no neurological symptoms prior to epidural anesthesia. The diagnosis was confirmed by a medical test called myelography in all cases. The epidurals were uneventful and performed according to standard methods.
Arachnoiditis is probably caused from the epidural injection of foreign substances (the anesthetic itself or contaminants in the solution) into the spinal canal.
Subarachnoid cysts can occur in the spine from arachnoiditis produced from the epidural anesthetic.67

b. Paralysis can occur.68 The injection of the local anesthetic into the epidural space can result in the veins becoming engorged, the spinal cord suffering from a lack of oxygen (hypoxia) and the woman developing acute neurological problems. Some of these deficits can become permanent.69 Paralysis can also occur from bleeding into the area during the epidural injection with the formation of a pocket of blood pressing on the spinal cord (hematoma). It can also occur from infection or trauma.
Cranial nerve paralysis can occur at quite a distance from the site of the epidural. This is thought to occur from traction on the spinal cord.70
Paralysis can occur from a condition called anterior spinal artery syndrome after epidural anesthesia during labor.71 Paralysis can occur when the blood flow to the spinal cord becomes so limited that tissue dies. This is called an infarction. A case report of an infarction after epidural anesthesia has been published in which leg paralysis occurred and did not recover. A loss of sensation to pain and temperature also occurred to the level of the mid-chest which partially resolved.72
Of 108 non-fatal complications in one study, five were associated with permanent disability.73 These included damage (neuropathy) to a single spinal nerve, acute toxicity from the local anesthetic, and problems associated with accidental puncture of the dura to become a spinal anesthetic.
Another patient developed paralysis after epidural anesthesia probably due to the anterior spinal artery or central arteries being blocked during the epidural and leading to death of part of the spinal cord.74
Neuropathy is a condition in which sensory changes occur (loss of sensation or hypersensitivity to sensation) with or without chronic pain. Neuropathy occurs after epidural anesthesia. It can occur from thrombosis of an artery from trauma from the epidural injection or from the catheter. A lack of adequate blood flow (and therefore oxygen) is called ischemia. This can cause neuropathy also.75"

Jag länkar hela artikeln hit:
http://www.healing-arts.org/mehl-madrona/mmepidural.htm#medical_risks_epidurals_neurological

Jag har tagit mig friheten att citera en del innehåll från artikeln och bifogar länken till hela artikeln ovan. Den är mycket läsvärd.

Sammanfattningsvis kan jag konstatera att det finns en hel del forskning på epiduralskador även utomlands sedan många år tillbaka.

Kända biverkningar är bland annat myelit som är min diagnos och även svår migränliknande huvudvärk som flera av de andra skadade kvinnorna har och andra besvär som omtalas i artikeln.

Varför får vi då inte ersättning från patientförsäkringen när det här är känt sedan lång tid tillbaka?

I artikeln talas det även om att vi är underinformerade om riskerna kring epiduraler även om inte alla blir skadade av epidural. Det  vore väl rimligt att informeras om möjliga negativa effekter av epidural när det kan bli en så här negativ skadeutveckling. Precis som Jenny skrev i mitt förra blogginlägg, jag citerar:

"Jag lägger mitt liv, mitt barns liv i vårdens händer och de kan inte ens ge information!
Jag tänker på EDA i detta fall. 

Varför får man inte veta riskerna?

Skulle jag/vi vara beredda att ha värk resten av livet för en mindre smärtsam förlossning?
Är beredd och säga nej för alla kvinnor/familjer där ute.

Dessutom kan EDA "förstöra" värkarbetet.
 

Varför blev jag inte informerad?
Vet vården inte själva om detta?
Vad har de för rutin kring detta?

Ja det kommer alltid finnas frågor och vem ska svara på dem?

Något vi alla har rätt och veta för att kunna ta ett bra beslut!
 

Många kvinnors/familjers liv är förstörda. 

Men vem ska hållas ansvarig, var kan vi få stöd och hjälp?

Vem kan hjälpa oss?"

Bra ställda frågor av Jenny tycker jag. Så den stora frågan är då:

"Vem ska hjälpa oss som har hamnat i den här jobbiga situationen"? 

Det går väl inte att reparera våra skadade kroppar men ett erkännande och upprättelse vore snyggt och även skadestånd och livränta som kompensation för våra förstörda liv vore absolut rimligt och självklart att få.   

För framtiden önskar jag att gravida kvinnor blir upplysta om riskerna med epiduraler och därmed har möjlighet att göra ett eget bra val. Baserat på alla kända biverkningar -  INNAN förlossningen,  i lugn och ro, både skriftligt och muntligt.  Jag kan förstå att det verkar avlägset och otroligt osannolikt med den låga skaderisken som finns i statistiken  att just jag skulle kunna bli drabbad av skador vid epidural. Men ingen vill nog vara den där personen som blir skadad, det är nog helt klart.

Som jag har skrivit tidigare så undrar jag hur skadestatistiken är framtagen. Är den bara baserad på skador rapporterade från anestesiklinikerna eller kvinnoklinikerna?  Isåfall finns det nog ett stort mörkertal. Ingen av oss skadade kvinnor som jag har kontakt med ingår i statistiken iallafall. 

Så frågan återstår, vem ska hjälpa oss som har blivit skadade?
 
Jag återkommer till det som jag har tagit upp flera gånger:

"Det kan väl ändå inte vara vårt fel att vi har blivit skadade av epidural vid våra förlossningar och fått våra liv förstörda"

 


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