Conversion Rate of Epidural Analgesia to Caesarean Section Regional or General Anesthesia

Autor: Šklebar, Ivan, Vrljičak, Marija, Habek, Dubravko, Šklebar, Tomislav, Šakić, Livija
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Acta clinica Croatica
Volume 61.
Issue Supplement 2
ISSN: 1333-9451
0353-9466
Popis: Introduction: Epidural analgesia is acknowledged as the most common method of analgesia during labor. If emergent Caesarean section (CS) is indicated in parturient with existing labor epidural, the need for conversion from epidural analgesia to regional (RA) or general anesthesia (GA) increases accordingly. Recent guidelines suggest the rate of conversion to general anesthesia shows the quality of obstetric anesthesia care and should be under 5%. The aim: The aim of this study is to determine the conversion rate from epidural analgesia to Caesarean section anesthesia in “Sveti Duh” University Hospital Zagreb in order to enhance the quality of anesthetic care for obstetric patients. Methods: We retrospectively included in the study all parturients who received epidural labor analgesia but needed subsequent regional or general anesthesia for Caesarean section in our institution for the period of 1st January 2021 to 31st December 2021. After the data analysis on the conversion rate from epidural analgesia to Caesarean section anesthesia had been performed, we compared our data to current standards and relevant literature findings. Results: Altogether 1202 epidural catheters were placed for labor analgesia in the study period, and in 199 of these cases, the emergent Caesarean section was indicated. Epidural analgesia was converted to epidural anesthesia (EA) in 153 (76,9%) parturients, to general anesthesia in 40 (20,1%), and to spinal anesthesia (SA) in six (3%) parturients. After comparison with recommended quality standards and with the results of similar studies by other authors, our findings show a significantly higher rate of conversion from epidural analgesia to general anesthesia than has been desirable since then. Conclusion: In order to reach the required quality standards regarding the conversion rate from epidural analgesia to Caesarean section anesthesia, it is necessary to improve the organization of the work of the obstetric anesthesiology team according to the principle of subspecialization. It is imperative to implement the best clinical practice protocols for obstetric anesthesiologists, but also to enhance the communication and coordination with the obstetric team.
Uvod: Epiduralna analgezija za porođaj danas je najčešća metoda analgezije tijekom porođaja. Zahvaljujući tome sve češće se javlja potreba za konverzijom iz epiduralne analgezije u regionalnu ili opću anesteziju u slučaju indikacije za hitni carski rez. Prema standardima kvalitete konverzija u opću anesteziju ne bi trebala prelaziti 5%. Cilj: Na vlastitom uzorku provesti analizu prakse konverzije epiduralne analgezije u anesteziju za carski rez retrospektivnom analizom jednogodišnjeg razdoblja kako bi se utvrdila područja za poboljšanjem u dnevnoj praksi. Ispitanici i metode: Analizirana je učestalost i konverzije epiduralne analgezije u regionalnu ili opću anesteziju u razdoblju od 01. 01. 2021. do 31. 12. 2021. Dobiveni podaci o učestalosti konverzije u pojedinu vrstu anestezije za carski rez uspoređeni su sa standardom kao i podacima sličnih istraživanja. Rezultati: Tijekom ispitivanog razdoblja stavljena su 1202 epiduralna katetera za analgeziju porođaja od čega je u 199 slučajeva nastupila indikacija za hitni carski rez te je epiduralna analgezija u 153 (76,9%) slučaja konvertirana u epiduralnu anesteziju, u 40 (20,1%) slučajeva u opću anesteziju i u 6 (3%) slučajeva u spinalnu anesteziju. Usporedba dobivenih rezultata s rezultatima drugih autora kao i zadanim standardima kvalitete ukazuje na značajno višu učestalost konverzije epiduralne analgezije u opću anesteziju u odnosu na poželjno. Zaključak: Za približavanje svjetskim standardima kvalitete opstetričke anestezije u segmentu konverzije epiduralne analgezije u anesteziju za carski nužno je unaprijediti organizaciju rada opstetričkog anesteziološkog tima prema principu subspecijalizacije. Potrebno je uvesti jasne zajedničke protokole za rad opstetričkih anesteziologa te unaprijediti komunikaciju i koordinaciju s opstetričkim timom.
Databáze: OpenAIRE
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