Survey of anaesthetic support staff in obstetric units in England and Wales

[Obstetric anesthesia in Catalonia, Spain]

BACKGROUND AND OBJECTIVE

The aim of this arm of the ANESCAT 2003 study was to describe obstetric anesthesia and analgesia practice in Catalonia, Spain.

PATIENTS AND METHOD

Using information obtained from a survey of anesthesia performed in Catalonia in 2003, data was identified on anesthesia for obstetric procedures: labor, cesarean section, and others unrelated to childbirth. Patient characteristics were analyzed along with anesthetic techniques and the rates at which they are used in the population.

RESULTS

Obstetric procedures were performed in 71 hospitals (54% of the hospitals surveyed). Obstetric anesthesia represented 11.3% of total anesthesia practice, corresponding to an estimated 67,864 anesthetic procedures per year. Of those procedures, 87.7% were associated with labor and childbirth. An estimated 82% of the 71,851 births in Catalonia were assisted by an anesthesiologist. Cesarean sections accounted for 25.1% of births and the rate increased with age. Regional anesthesia for labor and cesarean section was used in 98.7% and 96.2% of cases, respectively. Epidural anesthesia was used in 96.9% of vaginal births. In elective and emergency cesarean sections, spinal block was used in 75.5% and 44.8% of cases, respectively, while epidural anesthesia was used in 23.3% and 53.3%, respectively.

CONCLUSIONS

The anesthesia coverage for labor in Catalonia is the highest published. The use of regional anesthetic techniques in Catalonia is also the highest recorded. Although continuous epidural anesthesia is the most widely used technique, spinal block is also increasingly employed.

Demande d'analgésie périmédullaire par les patientes et les équipes obstétricales dans quatre régions françaises. Partie II : réalisation des analgésies périmédullaires

OBJECTIVE

Epidural analgesia (EA) is widely used in France to treat the labour pain. The aim of this study was to evaluate and analyse the rate of EA and the ratio between EA required by parturients and total EA realised (performance ratio).

STUDY DESIGN

An epidemiological survey was sent in all maternity units of 4 French areas. Patients and methods. - 48 of the 84 maternity units were participating to the study. In each centre, 25 patients fulfilled the questionnaire and the medical team fulfilled a questionnaire about the organisation of the ward. Rate of EA and performance ratio were calculated. Student t test, chi2 test and logistic regression model were used as requested; p<0.05 was considered as significant.

RESULTS

The mean rate of epidural analgesia (EA) rate, in the French areas studied, was 61.6%. It was significantly higher in university (79+/-13.7%) and private hospital (73.1+/-20.4%) than in general hospitals (54.6+/-19.6%, p<0.01), and also in those where anaesthesiologists are dedicated to the maternity unit (71.3+/-17.8 vs 54.6+/-22.1%, p<0.01) and in hospitals where anaesthesiologists were on duty in the hospital versus on call at home (69.8+/-21.4 vs 56.1+/-19%, p<0.02). Median duration of EA was 180 minutes, and 21.3% of them lasted more than five hours. Most of EA was performed between 8 AM and 6 PM. Patients' request was the major reason of EA insertion (OR=11.81), then the midwife request (OR=9.01). Other significant factors were the type of the hospital, the anaesthesiologist on duty and parity of women. The ratio between the number of EA requested by parturients and the total number of EA performed was significantly better in university hospitals (100.3+/-13%) and private hospitals (92.2+/-15.7%) than in general hospitals (79.4+/-17.3%, p<0.02). For the patients who had requested EA and did not have EA, the main reason was that labour was too fast (122/167) and then that there was a fail in anaesthesiological organization (59/167). The contraindications were rare (14/167).

CONCLUSION

To correctly answer to the request of EA, it seems necessary that one or more anaesthesiologists were dedicated to the maternity units, and that they were on duty into the hospital. So it seems important to have large maternities with adequate number of anaesthesiologists.