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International Journal of Obstetric Anesthesia (2005) 14, 126-146

Gerard W Ostheimer Lecture 2004

L. C. Tsen


Что нового и нестандартного в акушерской анестезии?
Вклад в научную литературу, начиная с 2003 года.
(Часть 2)

Разное

Согласие

Информированное согласие - растущий результат, который основывается на двух основных принципах медицинской этики, милосердии и независимости. Милосердие – это применение врачом его или ее специальных знаний на благо пациента. Независимость - это использование больным саморешения, направляемого врачом на выполнение только клинических решений, которые касаются успеха для больного. Хотя, по-видимому, на преимущества друг друга, они не взаимно исключимы. Какой бы принцип не преобладал, информированное согласие зависит от знаний неотъемлемого риска и успеха. Jenkins и Baker [348] провели обзор литературных данных по оценке и сообщили о частоте анестезиологических осложнений. Неотъемлемые дебаты для акушерской анестезии, начало родов, как отмечается, не компрометирует способность слышать и понимать информацию [349, 350]; наличие родов, таким образом, не лишает законной силы процесс получения согласия. Тем не менее, юридическая сила информированного согласия, информированного отказа и информированного выбора в родах остается противоречивой; анестезиолог, в поисках руководств, может получить некоторое понимание акушерской перспективы [351]. Хотя процесс согласия может оказаться растущим более тяжким, выше источники предполагают, что когда процесс согласия используется, как подразумеваемый, а не как противостоящий от защиты неправильной практики, он может усилить взаимодействие между больным и врачом и вовлечь больного в уход за собой.

Этика

Близко относится к теме информированного согласия медицинская этика, определяемая как дисциплинированное исследование морали в медицине [352]. Такие этические допущения добродетели, которые определяются врачом и его/ее действиями по отношению к больному. Chervenak с соавторами [352] обсуждали медицинскую этику в отношении акушерской анестезии. Они предложили их четыре добродетели: само-забвение, само-пожертвование, сострадание и практическое согласование со стандартами интеллектуального и морального превосходства. Результаты выработаны АКАГ по общему мнению по этике принимаемого решения [353] и этические рассмотрения в научном исследовании, вовлекающем женщин [354]. Такие размышления уместны в клиническом уходе Jehovah Witness [355] или у родильниц с нежеланием применять нейроаксиальную аналгезию [356].

История

В переводе библейского утверждения относительно боли в родах, слово «боль» может иметь неправильную интерпретацию и может в действительности означать «тяжелый труд». Исторические работы по методу кесарева сечения [357], операция впервые документированная в 1480 году и ранние годы акушерской анестезии [358] прибавляют оценку глубины нашей специальности.

Поддержка в родах

В базе Cohrane обзор 15 исследований включающем 15791 женщин, Hodnett с соавторами [359] нашли, что длительная поддержка в родах вызывает больше успеха, когда поддерживающее лицо входит в штат госпиталя и присутствует с начала родов, и где эпидуральная аналгезия рутинно не используется. Присутствие отца также найдено успешным в текущей [360] и исторической [361] ссылках. Акушерки играют важную роль в поддержке в родах [362]. Mahlmeister [363] провел обзор некоторых осложнений, связанных с эпидуральной аналгезией в акушерстве, и выработал рекомендации для медицинских сестер.

Уведомление о вебсайтах/книгах/брошюрах/журналах

Появился ряд новых учебников и ресурсов. Журнал Clinical Anesthesia провел анонс того, что одна обзорная статья в итогах посвящена акушерской анестезии [364], и вебсайт акушерской анестезии для пациентов и профессионалов, которые получат желаемый обзор [365] есть на www . painfreebirthing . com .

Доктор Frederick Zuspan объявил о своей отставке после 24 лет в качестве главного редактора American Journal of Obstetrics and Gynecology . Среди революционных изменений, которые он упомянул в своем прощальном обращении [366], были «способность оценивать плода с помощью мониторирования сердцебиения плода, ультразвуковое исследование и образцы околоплодных вод или крови плода, а также прогресс в бесплодии и контрацепции». Это было частью «роста знаний, которые необходимо сообщать читающей общественности».

Такие утверждения обеспечивают внимательное резюме для этого обзора одного года «роста» в акушерской анестезии. Значительные изменения свидетельствуют о нашем понимании беременных женщин, плода и новорожденного и акушерства и акушерской анестезии. Отражением этих изменений в нашей жизни и в нашей практике, мы даем перспективу словам Emerson и практике Ostheimer . Способность поддерживать идеи, коллег, пациентов, членов семьи и друзей действительно является даром, который может волновать тысячи.

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