Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice.
There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction.
Crawford-Sykes
A
A
Department of Surgery, Radiology, Anaesthesia and Intensive Care, Section of Anaesthesia, The University of the West Indies, Kingston 7, Jamaica. crawfsyk@cwjamaica.com
Scarlett
M
M
Hambleton
I R
IR
Nelson
M
M
Rattray
C
C
D000765:Anesthesia, Conduction; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008428:Maternal Mortality; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014900:West Indies / Q000453:epidemiology