Sažetak
Background:The aim of this audit was to evaluate the frequency of caesarean delivery, anaesthetic techniques employed, investigate potential trends and the rate of maternal complications associated with general or regional anaesthesia in our institution.
Methods: We reviewed data collected on all deliveries from patients’ medical records, anaesthetic charts and relevant surgical notes from 1 January 2008 to 31 December 2010.
Results: A total of 10,911 deliveries were conducted during the study period and there were 3389 caesarean sections, giving a rate of 31.1%; which showed an upward trend from 27.8% in the first year to 34% in the third year. Our data showed a predominant use of regional anaesthesia for caesarean section generally (86.2%) and 83.8% for emergency caesarean deliveries in line with global trends. The overall complication rate was 10.5%. However, 34.5% of parturients who had general anaesthesia in contrast with 6.7% who had regional techniques had anaesthesia-related complications, postoperative intensive care unit admission rather than recovery room care, intra-operative cardiac arrest and haemorrhage exceeding 1200ml (p = 0.001). Haemodynamic fluctuations were the most common anaesthesia-related complication. Our data revealed that general anaesthesia was a significant risk factor for maternal complications.
Conclusion: Obstetric general anaesthesia is low in our hospital. Our result showed that general anaesthesia was a significant risk factor for maternal complications during caesarean section.
Keywords: Caesarean deliveries; anaesthesia; maternal complications; risk factor.
Résumé
Introduction: Le but de cet audit étaitd’évaluer la fréquence des accouchements par césarienne, les techniques anesthésiques employées, d’enquêter sur les tendances, le taux de complication maternelle associés à l’anesthésie générale ou régionale dans notre institution.
Méthodes: Nous avons passées en revue, un certain nombre de donnéesde tous les dossiers médicaux des patients pendant les accouchements, les graphiques anesthésiques et les notes chirurgicales pertinentes du 1er Janvier 2008 au 31 Décembre 2010.
Résultats: Au total 10,911 accouchements ontété accomplis pendant la période d’étude, un total de 3,389 césariennes, pour un taux de 31.1 %; une augmentation de 27.8 % de la première année à 34 % à la troisième année. Nos données ont montré une utilisation prédominante d’anesthésie régionale de la césarienne générale (86.2 %), et 83.8 % pour les césariennes d’urgence conformément aux tendances globales. Le taux de complication général est de 10.5 %. Pourtant, 34.5 % de parturientes qui avaient eu l’anesthésie générale par contraste avec 6.7 % qui avaient eu des techniques régionales avaient des complications concernant l’anesthésie, des service de soins intensifs post chirurgical dans l’unité d’admission plutôt que la salle des soins de récupération, l’arrêt cardiaque intra-chirurgical et l’hémorragie excédant 1200 millilitres (p = 0.001).
Conclusion: Les fluctuations hémodynamiques étaient la complication concernant l’anesthésie la plus commune. L’anesthésie obstétrique générale est faible dans notre hôpital. Nos données ont révélé que l’anesthésie générale était un facteur de risque significatif pour les complications maternelles durant la section césarienne.
Correspondence: Dr. Ambrose Rukewe, Department of Anaesthesia, University College Hospital, Ibadan, Nigeria. Email: ambyrukewe@gmail.com
Reference
Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia 2008;63:822-832
Palanisamy A, Mitani AA and Tsen LC. General anesthesia for cesarean delivery at a tertiary care hospital from 2000 to 2005: a retrospective analysis and 10-year update. Int J Obstet Anesth 2011;20:10-16
Okafor UV and Okezie O. Maternal and fetal outcome of anaesthesia for caesarean delivery in pre-eclampsia/eclampsia in Enugu Nigeria: a retrospective observational study. Int J Obstet Anesth 2005;14:108-113.
Enohumah KO and Imarengiaye CO. Factors associated with anesthesia-related maternal mortality in a tertiary hospital in Nigeria. Acta Anaesthesiol Scand 2006;50:206-210.
Desalu I and Afolabi BB. Urgency of surgery and presence of maternal disease influence the choice of anaesthesia for Caesarean section at LUTH. Nig Postgrad Med J 2007;14:114-117.
Lamina MA. Trends in regional anaesthesia for caesarean section in a Nigerian tertiary health centre. West Afr J Med 2009;28:380-383.
Dean AG, Sullivan KM and Soe MM. OpenEpi: Open source Epidemiologic Statistics for Public Health, Version 2.3. www.Open Epi.com, updated 2009/20/05, accessed 2012/04/10.
Nafiu OO and Elegbe EO. The disappearing art of obstetric general anaesthesia in the UK: implications for overseas trainees. Int J Obstet Anesth 2005;14:273.
Declercq E, Young R, Cabral H and Ecker J. Is a Rising Cesarean Delivery Rate Inevitable? Trends in Industrialized Countries, 1987 to 2007. Birth 2011;38:99-104.
Rebelo F, Da Rocha CMM, Cortes TR, et al. High cesarean prevalence in a national population-based study in Brazil: the role of private practice. Acta Obstet Gynecol Scand 2010;89:903-908.
Kan RK, Lew E, Yeo SW and Thomas E. General anaesthesia for cesarean section in a Singapore maternity hospital: a retrospective survey. Int J Obstet Anesth 2004; 13:221-226.
Bowring J, Fraser N, Vause S and Heazell AE. Is regional anaesthesia better than general anaesthesia for caesarean section? J Obstet Gynae 2006;26:433-434.
Russell IF. Raising the standard: a compendium of audit recipes. 2006. Technique of anaesthesia for caesarean sections; pp. 166-167.
Chan Y K and Ng K P. A survey of regional analgesia and anaesthesia for obstetrics in selected countries in the Far East. Int J Obstet Anesth 2000;9:225-232.
Bucklin BA, Hawkins JL, Anderson JR and Ullrich FA. Obstetric Anaesthesia Workforce Survey. Twenty year update. Anesthesiology 2005;103:645-653.
Pallasmaa N, Ekblad U, Aitokallio-Tallberg A, et al. Caesarean delivery in Finland: Maternal complications and obstetric risk factors. Acta Obstet Gynecol Scand 2010;89:896-902.
Hager RM, Dalveit AK, Hofoss D, et al. Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol 2004;190:428-434.
Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226-1232.
Hawkins JL, Chang J, Palmer SK, et al. Anesthesia-related maternal mortality in the United States, 1997–2002. Obstet Gynecol 2011;117:69-74.
Wong CA. General anaesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth 2010; 19:209-217.