[關於反芻動物全身麻醉的風險，反芻動物中，全身麻醉的弊大於利。] 有興趣的朋友可以多了解一下喔! (中文翻譯的部分為Google翻譯的，能夠閱讀英文的朋友建議看原文會比較清楚喔)
還有很多很多相關的學術發表，就不貼那麼多出來啦!

Cooper結紮的日期是4月26日，他現在很健康很調皮。

(德叔真的超級超級愛看這些學術發表的文章，但是我還是相信醫生的專業。)

https://www.researchgate.net/publication/334673867_The_Use_of_Epidural_Anaesthesia_over_General_Anaesthesia_in_Ruminants
全身麻醉是現代醫學的重要組成部分。它是一種藥物誘導的可逆病症，包括特定的行為和生理特徵，包括無意識、健忘症、鎮痛和運動不能——伴隨自主神經、心血管、呼吸和體溫調節系統的穩定性。
[反芻動物全身麻醉具有內在風險，如瘤胃內容物反流、唾液分泌過多和肺部誤吸的可能性；因此並不總是推薦使用本地或區域技術。硬膜外麻醉是一種中樞神經阻滯技術，經常用於獸醫實踐中，用於治療家畜會陰、骶骨、腰椎和尾椎部位的不同產科和外科手術干擾。關於在反芻動物和其他物種的各種外科和實驗室程序中使用硬膜外麻醉的科學研究已經有幾項。總之，全身麻醉的弊大於利，特別是在反芻動物中。因此，硬膜外麻醉是首選。

General anaesthesia is an essential component of modern medicine. It is a drug induced reversible condition that includes specific behavioral and physiological traits unconsciousness, amnesia, analgesia, and akinesia- with concomitant stability of the autonomic, cardiovascular, respiratory, and thermoregulatory systems.
[General anesthesia in ruminants has inherent risks such as regurgitation of ruminal contents, excessive salivation and the possibility of pulmonary aspiration; therefore it is not always recommended and local or regional techniques may be used instead. Epidural anaesthesia is a central neuraxial block technique which is used regularly in veterinary practice for treatment of different obstetrical and surgical interferences in the perineal, sacral, lumbar, and caudal parts of the thoracic region of domestic animals. There have been several scientific researches on the use of epidural anesthesia in ruminants and other species for various surgical and laboratory procedures. In conclusion, the disadvantages of general anaesthesia outweigh the advantages especially in ruminant specie. Therefore, epidural anaesthesia is the most preferred.

https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118886700.ch1
瘤胃鼓脹、腹脹、反流和吸入性肺炎是與家畜全身麻醉相關的常見問題，應通過適當的預防措施和必要的麻醉前考慮來預見和解決。家畜在麻醉期間可能會出現胃內容物反流和誤吸，尤其是未禁食的動物。反芻動物在麻醉期間通常會大量分泌唾液。惡性高熱的觸發因素包括壓力（例如興奮、運輸或麻醉前處理）、鹵化吸入麻醉劑（例如氟烷、異氟烷、七氟烷和地氟烷）和去極化神經肌肉阻滯藥物（例如琥珀膽鹼）。同樣，氟烷似乎是豬惡性高熱的最有效和最常見的觸發因素。麻醉前禁食可能不能完全防止反流，但會減少瘤胃內容物中的固體物質數量。獸醫應將這些知識與適當的麻醉前準備和適當的圍手術期管理相結合，以確保這些動物的麻醉成功。
Ruminal tympany, bloat, regurgitation, and aspiration pneumonia are common problems associated with general anesthesia in farm animal species that should be anticipated and addressed with proper precautions and the necessary preanesthetic considerations. Regurgitation and aspiration of stomach content can occur in farm animal species during anesthesia, especially in nonfasted animals. Ruminants normally salivate profusely during anesthesia. The triggering agents of malignant hyperthermia include stress (e.g., excitement, transportation, or preanesthetic handling), halogenated inhalation anesthetics (e.g., halothane, isoflurane, sevoflurane, and desflurane), and depolarizing neuro-muscular blocking drugs (e.g., succinylcholine). Similarly, halothane appears to be the most potent and most frequently reported trigger of malignant hyperthermia in pigs. Preanesthetic fasting may not completely prevent regurgitation, but it will decrease the amount of solid matter in the rumen content. Veterinarians should incorporate the knowledge with proper preanesthetic preparations and appropriate perioperative management to ensure successful outcome of anesthesia in these animals.

還在討論該不該剪會陰嗎？那麼你們已經看不到好孕的車尾燈囉！
謝謝丹麥助產師朋友兩年前的討論，鼓勵我放開保護會陰的手，開始做“hands-off"的接生。

In Denmark, midwives - and obstetricians - use different perineal techniques to avoid perineum damages and only do episiotomies in rare cases. Also, they usually do not actively try to stretch the perineum 'manually 'during birth. Instead, they try to slow down the birth of the baby's head to allow the perineum to stretch slowly to prevent injury. ('Hands off' instead off 'hands on'). Often warms compresses on the perineum are used as pain relief. These techniques are being taught in midwifery school and at the hospitals from midwife/doctor to student.

參考文獻 https://pubmed.ncbi.nlm.nih.gov/31092083/

那天講座，我說這四年來的前兩百個產婦，會陰切開執行率是2%，而且接下來只會更低，現場響起掌聲。

需不需要做會陰切開，關係著產婦孕期作的準備，還有接生者的知識與技術系統。

美國已經從12%降到5%了！
An episiotomy is an incision made in the perineum (the birth canal) during childbirth. Although episiotomies were once routine in childbirth, medical guidelines today recommend an episiotomy only in a narrow set of cases. Episiotomies have been clearly linked with worse perineal tears, loss of bladder or bowel control, and pelvic floor defects. These complications slow the mother’s recovery and increase delivery costs. Due to these concerns, the American College of Obstetricians and Gynecologists (ACOG) has called for the restricted use of episiotomy, which has been firmly linked to lower rates of perineal injury.

Leapfrog has tracked hospitals' rate of episiotomy since 2012. In 2015, at the guidance of its expert panel, Leapfrog reduced its target rate for episiotomy to 5%, down from 12%, to further reflect literature indicating the limited degree to which episiotomy should be used.

https://www.leapfroggroup.org/ratings-reports/rate-episiotomy

還可以參考這篇 四月The New York Times的討論，有講到這個處置的歷史
https://www.nytimes.com/2020/04/17/parenting/episiotomy.html

台灣加油！

好孕團隊不會滿足於台灣第一，而是要邁向世界第一！

#沒有最好只有更好

妳的坐月子計畫包含了「產後護理」嗎？即使順產，也可能在生產過程中經歷不同程度的創傷，例如：陰部腫脹、會陰撕裂、會陰測切傷口或痔瘡…等，事先準備好產後護理包，爭取產後第一時間開始進行必要護理，讓傷口在2周內輕鬆恢復！📢 快來訂閱我的頻道：http://bit.ly/2kttyum

本影片僅供教育使用，不能取代醫生診斷。請向醫生或其他合格醫療人員諮詢您的病情。

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