Obstetrical anesthesia – Czech Republic versus world

Česká verzia

Authors: Jan Bláha
Authors place of work: Expertní skupina porodnické anestezie a analgezie při ČSARIM ; Klinika anestezie, resuscitace a intenzivní medicíny 1. LF UK a VFN, Praha, přednosta doc. MUDr. Martin Stříteský, CSc.
Published in the journal: Prakt Gyn 2013; 17(4): 287-292
Category: Gynecology and Obstetrics: Review Article

Summary

In the Czech Republic nearly a one quarter of all births ends with Caesarean section and it is supposed that the tendency will continue to rise despite of all efforts done, due to the increasing age of mothers, their higher morbidity, increasing number of states after previous Caesarean section and many other causes. Undoubtedly it is partly due to reduced willingness of obstetricians to risk spontaneously managed delivery in uncertain obstetric situations. Increasing number of Caesarean sections increases importance and influence of administered anesthesia. Similarly as in the world, we have noticed continuos rise of the use of regional anesthesia compared with general anesthesia in our records from the last 20 years, so nowadays it prevails. All previously mentioned looks good. If we look at statistical data it shows an alarming gap between the Czech Republic and the rest of the world. In 2011 in the Czech Republic 53% of Caesarean sections were performed under regional anesthesia and 47% under general anesthesia. Just for comparison, in mostly medically developed countries, the use of general anesthesia for Caesarean section does not exceed 15%! We can find the reason of that mainly in the rigidity and conservatism of Czech obstetrics and in aversion to regional anesthetic techniques in many centers which is difficult to understand. Therefore, this article tries to explain the reasons for the worldwide preference of regional anesthesia for Caesarean section and thus encourage the centers where the regional techniques still represent source of useless doubts.

Key words:
Caesarean section – choice of anesthesia – general anesthesia – obstetrical anesthesia – regional anesthesia

Zdroje

1. The World Bank. Maternal mortality ratio (modeled estimate, per 100,000 live births). Dostupné z WWW: <http://data.worldbank.org/indicator/SH.STA.MMRT>.

2. Nosková P, Bláha J, Klozová R et al. Mýty a realita porodní analgezie ČR: OBAAMA-CZ projekt 2012. Bolest 2012; 15(Suppl 1):18.

3. Štourač P. Obstetric Anaesthesia and Analgesia Month Attributes – reálná zpráva o anesteziologické praxi na českých porodních odděleních. Anest intenziv Med 2013; 24(2): 81–82.

4. Marusičová P. Porodnická anestezie a analgezie v zahraničí. In: Pařízek A (ed) et al. Analgezie a anestezie v porodnictví. Galén: Praha 2012: 391–397. ISBN 9788072629497.

5. Furmanik J. A survey of anaesthesia for Cesarean section in Poland. Anestezjol Intens Ter 2010; 42(2): 65–69.

6. Pařízek A, Bláha J, Nosková P. Porodnická analgezie a anestezie v České republice v roce 2012. 20. výročí programu postgraduálního vzdělávání. Česká gynekol 2012; 77(4): 246–249.

7. Křížek Č. Základové porodnictví pro lékaře: se zvláštním zřetelem k části operativní. Tiskem a nákladem knihtiskárny Josefa Koláře, Praha 1876.

8. Chestnut DH, Polley LS, Tsen LC (eds) et al. Chestnut‘s Obstetrics Anesthesia: Principles and Practice. 4th ed. Mosby, Elsvier: Philadelphia 2009. ISBN-10: 0323055419 | ISBN-13: 978–0323055413.

9. Klaus R. K otázce lumbální anesthesie při císařském řezu. Rozhl Chir Gyn 1934; 13: 31–97.

10. Kříž J. Epidurální nervový blok v porodnictví. Scripta medica 1953; 3: 93–104.

11. Pařízek A. Historický vývoj porodnické analgezie a anestezie v České republice. In: Pařízek A (ed) et al. Analgezie a anestezie v porodnictví. Galén: Praha 2012: 13–17. ISBN 9788072629497.

12. Blaha J. Expertní skupina porodnické anestezie a analgezie (ESPAA). Anest intenziv Med 2013; 24(2): 89–90.

13. Betran AP, Merialdi M, Lauer JA et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21(2): 98–113.

14. Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003; 58(11): 1114–1118.

15. Mardešičová N, Velebil P. Epidemiologie císařského řezu. Postgrad med 2010; 2: 171–174.

16. Marcus HE, Behrend A, Schier R et al. Anesthesiological management of Caesarean sections: nationwide survey in Germany. Anaesthesist 2011; 60(10): 916–928.

17. Bucklin BA, Hawkins JL, Anderson JR et al. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 2005; 103(3): 645–653.

18. Wilkins KK, Greenfield ML, Polley LS et al. A survey of obstetric perianesthesia care unit standards. Anesth Analg 2009; 108(6): 1869–1875.

19. Tsai PS, Hsu CS, Fan YC et al. General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study. Br J Anaesth 2011; 107(5): 757–761.

20. Van Houwe P, Heytens L, Vercruysse P. A survey of obstetric an aesthesia practice in Flanders. Acta Anaesthesiol Belg 2006; 57(1): 29–37.

21. Weiniger CF, Ivri S, Ioscovich A et al. Obstetric anesthesia units in Israel: a national questionnaire-based survey. Int J Obstet Anesth 2010; 19(4): 410–416.

22. Benhamou D, Bouaziz H, Chassard D et al. Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. Eur J Anaesthesiol 2009; 26(8): 694–700.

23. Bláha J, Nosková P, Klozová R et al. Současné postupy v porodnické anestezii I – peroperační péče u císařského řezu. Anest intenziv Med 2013; 24(2): 91–101.

24. Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010; 105(Suppl 1): i50-i60.

25. Oppenheimer L (Society of Obstetricians and Gynaecologists of Canada). Diagnosis and management of placenta previa. J Obstet Gynaecol Can 2007; 29(3): 261–273.

26. Visalyaputra S, Rodanant O, Somboonviboon W et al. Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. Anesth Analg 2005; 101(3): 862–868.

27. Levy DM. Emergency Caesarean section: best practice. Anaesthesia 2006; 61(8): 786–791.

28. Hawkins JL. Anesthesia-related maternal mortality. Clin Obstet Gynecol 2003; 46(3): 679–687.

29. Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2006; 4: CD004350.

30. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005; 60(7): 636–653.

31. Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia 2005; 60(2): 168–171.

32. McDonnell NJ, Paech MJ, Clavisi OM et al. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth 2008; 17(4): 292–297.

33. Lyons G, Akerman N. Problems with general anaesthesia for Caesarean section. Minerva Anestesiol 2005; 71(1–2): 27–38.

34. Barnardo PD, Jenkins JG. Failed tracheal intubation in obstetrics: a 6-year review in a UK region. Anaesthesia 2000; 55(7): 690–694.

35. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. The Cochrane database of systematic reviews 2012; 10: CD004350.

36. Chang CC, Wang IT, Chen YH et al. Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries. Am J Obstet Gynecol 2011; 205(5): 462.e461-e467. Dostupné z DOI: <http://doi: 10.1016/j.ajog.2011.06.068>.

37. Fassoulaki A, Petropoulos G, Staikou C et al. General versus neuraxial anaesthesia for caesarean section: impact on the duration of hospital stay. Journal of obstetrics and gynaecology. J Obstet Gynaecol 2009; 29(1): 25–30.

38. Saracoglu KT, Saracoglu A, Cakar K et al. Comparative study of intravenous opioid consumption in the postoperative period. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156(1): 48–51.

39. Kessous R, Weintraub AY, Wiznitzer A et al. Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception. Arch Gynecol Obstet 2012; 286(1): 75–79.

40. Langesaeter E, Dragsund M, Rosseland LA. Regional anaesthesia for a Caesarean section in women with cardiac disease: a prospective study. Acta Anaesthesiol Scand 2010; 54(1): 46–54.

41. Dahl V, Spreng UJ. Anaesthesia for urgent (grade 1) caesarean section. Curr Opin Anaesthesiol 2009; 22(3): 352–356.

42. Ismail S, Huda A. An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth 2009; 18(4): 352–355.

43. Kinsella SM, Girgirah K, Scrutton MJ: Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia 2010; 65(7): 664–669.

44. Popham P, Buettner A, Mendola M. Anaesthesia for emergency caesarean section, 2000–2004, at the Royal Women‘s Hospital, Melbourne. Anaesth Intensive Care 2007; 35(1): 74–79.

45. Sigalas J, Galazios G, Tsikrikoni I et al. The influence of the mode of anaesthesia in the incidence of neonatal morbidity after an elective caesarean section. Clin Exp Obstet Gynecol 2006; 33(1): 10–12.

46. Jain K, Bhardwaj N, Sharma A et al. A randomised comparison of the effects of low-dose spinal or general anaesthesia on umbilical cord blood gases during caesarean delivery of growth-restricted foetuses with impaired Doppler flow. Eur J Anaesthesiol 2013; 30(1): 9–15.

47. Algert CS, Bowen JR, Giles WB et al. Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study. BMC Med 2009; 7: 20.

48. Mancuso A, De Vivo A, Giacobbe A et al. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med 2010; 23(10): 1114–1118.

49. Laudenbach V, Mercier FJ, Rozé JC et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. Int J Obstet Anesth 2009; 18(2): 142–149.

50. Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001; 94(5): 888–906.

51. Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg 2004; 98(2): 483–490.

52. Tonni G, Ferrari B, De Felice C et al. Fetal acid-base and neonatal status after general and neuraxial anesthesia for elective cesarean section. Int J Gynaecol Obstet 2007; 97(2): 143–146.

53. Hillyard SG, Bate TE, Corcoran TB et al. Extending epidural analgesia for emergency Caesarean section: a meta-analysis. Br J Anaesth 2011; 107(5): 668–678.