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Is there such a thing as an Epidural dip???


Specializes in cardiac, diabetes, OB/GYN. Has 27 years experience.

I was just wondering if any of you have had this common thread regarding epidurals. It seems to those of us in my unit that not long after the epidural starts, there more often than not seems to be a dip in the FH which is transient and self limiting. It happens so often it seems, that we don't even really flinch.

Anesthesia says we are nuts and there is absolutely no reason that would occur..So, if any one out that has had similar experiences with epidurals, or even if you have NOT noticed the pattern that seems to be assailing us, please consider sharing...I would LOVE to see if there is a pattern so I could consider out anesthesia people the ones who are uninformed, for once...:):confused:

mother/babyRN, RN

Specializes in cardiac, diabetes, OB/GYN. Has 27 years experience.

I'm thinking maybe it IS us and some bad karma! :)

bagladyrn, RN

Specializes in OB.

Could it correlate to the drop in BP most women get shortly after epidural is started?

Originally posted by mother/babyRN

Anesthesia says we are nuts and there is absolutely no reason that would occur..

B.S.!!! Sorry, anesthesia is wrong. How about decreased uterine perfusion secondary to the natural drop in BP after an epidural??? Heh? Heh?? Anes. docs are so crabby about their 'craft.' Yes, we see it all the time, especially in docs who administer high loading doses with higher conc. of narcotics. You're not nuts.

mother/babyRN, RN

Specializes in cardiac, diabetes, OB/GYN. Has 27 years experience.

Oh thank God...THANKYOU for the validation....I was beginning to wonder if it was just us...

Vasodilation and relaxation cause a natural decrase in the maternal blood pressure--the first thing that happens to preserve the maternal vital organs is that blood is shunted away from the uterus/placenta. The whole purpose of the pre-epidural bolus is to counteract this effect. If the bolus is not given immediately prior to placement, if anesthesia gives a large loading dose, if there is any migration into the maternal vascular system or intrathecal injection AND when we (as nurses) lay the patient flat on her back to "promote good distribution" we facilitate these reflex decelerations. They are generally self-limiting or respond to fluid bolus and/or Ephedrine bolus--these only correct the maternal issue but the baby gets better--go figure....

Anesthesia loves to argue that this happens even when a drop in maternal blood pressure is not evident--but this is because the mother's physiology is to pull blood away from unnecessary areas (i.e., baby)--the other thing they don't look at is the mean BP--this is often more indicative of what's happening to Mom than the acutal BP itself.

Babies are the equivalent of the miners canaries--they'll crash first before Mom ever starts to feel/look bad.............Look at strips of abruptions, uterine ruptures, amniotic fluid embolus--I would bet money that the baby crashed first (not by much in case of AFE, but the kid crashing is still the first indication of trouble).....

mother/babyRN, RN

Specializes in cardiac, diabetes, OB/GYN. Has 27 years experience.

Now see, that is OUR position, but anesthesia continues to insist..Good to know nurses EVERYWHERE are the ones actually caring for the patient!:) I even kid the anesthesiologists, one of whom not too long ago came out of the room laughing because it had been a long hard road to 4-5 cms for one primip, and she was definitely physical in her manner of handling labor...He told us we all looked like hell ( he, of course, looked wonderful)...

He thought he was out of ear shot of the patient when he mentioned that, and, as it was the inevitable night shift and he wasn't happy about being called in, he turned to me, sneered and said " And YOU, look the worst...THAT chick will LOVE me for just a few minutes of my time...You're killing yourself and she won't remember you for more than the time you're with her. I opened my mouth prepared for some wise remark reply but I needn't have bothered, because out from the room came a remark in that screaming voice only laboring people have,m " Tell that ahole I am NOT a chick and he couldn't spend more than a couple minutes in here because he doesn't have it in him to do what my nurses have been doing ALL DAMN DAY LONG!

He blushed, I laughed and all was well...Our patients may love anesthesia for the time they are doing the epidural, but they love US forever.....:)

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