Desalu I, Afolabi B B
Department of Anaesthesia, College of Medicine University of Lagos, P.M.B 12003, Lagos.
Niger Postgrad Med J. 2007 Jun;14(2):114-7.
Worldwide, Caesarean sections are commonly done under regional anaesthesia which offers numerous advantages over general anesthesia. However there are still indications for the use of general anaesthesia in obstetric practice. This includes emergent Caesarean sections. This study sought to determine the factors that inform the decision on the choice of anaesthesia for Caesarean section in a tertiary institution in Nigeria.
All patients scheduled for elective and emergency caesarean sections between January and December 2002 were prospectively studied. Study variables included age of mother, gestational age and parity. Urgency of surgery, indication for surgery, maternal pre-existing disease and the choice of anaesthetic technique were documented. Neonatal weight was recorded and outcome was assessed by Apgar score at 1 and 5 minutes, the presence of respiratory difficulties and the need for admission into the Neonatal unit.
One hundred and ninety-six patients were studied. Elective surgery was performed for 17.3%, while 47.4% and 28.6% had urgent and emergency Caesarean sections respectively. Urgency of surgery was not documented in 6.7% of cases. Previous caesarean section was the commonest indication for elective procedures (47%), foetal distress for emergency (62.5%) and previous caesarean section in labour for urgent procedures (30.1%). General anaesthesia was employed in 33.2% of patients while regional anaesthesia was used in 66.8%. Fifty per cent of emergency cases had general anaesthesia. Regional anaesthesia was used in 72% of urgent and 85.3% of elective procedures. The commonest regional technique was spinal anaesthesia (60.7%). Nineteen per cent of our patients had a co-existing medical problem, and 73% of these received a spinal anaesthetic. More neonates delivered under general anaesthesia had respiratory difficulties at birth (p=0.002) and more were admitted to the Neonatal unit (p=0.031).
The choice of anaesthesia depends on the urgency of surgery and the medical condition of the mother. General anaesthesia was more likely to be administered for bleeding emergencies and foetal distress. Spinal anaesthesia was preferred for elective and urgent cases or when maternal disease existed.
在全球范围内，剖宫产通常在区域麻醉下进行，与全身麻醉相比具有诸多优势。然而，在产科实践中仍有使用全身麻醉的指征，这包括急诊剖宫产。本研究旨在确定尼日利亚一家三级医疗机构中影响剖宫产麻醉方式选择决策的因素。
对2002年1月至12月期间所有计划进行择期和急诊剖宫产的患者进行前瞻性研究。研究变量包括产妇年龄、孕周和产次。记录手术的紧急程度、手术指征、产妇既往疾病以及麻醉技术的选择。记录新生儿体重，并通过1分钟和5分钟时的阿氏评分、是否存在呼吸困难以及是否需要入住新生儿病房来评估结局。
共研究了196例患者。择期手术占17.3%，而急诊和紧急剖宫产分别占47.4%和28.6%。6.7%的病例未记录手术紧急程度。既往剖宫产是择期手术最常见的指征（47%），胎儿窘迫是急诊手术的最常见指征（62.5%），产时既往剖宫产是紧急手术的最常见指征（30.1%）。33.2%的患者采用全身麻醉，66.8%采用区域麻醉。50%的急诊病例采用全身麻醉。72%的紧急手术和85.3%的择期手术采用区域麻醉。最常用的区域麻醉技术是脊髓麻醉（60.7%）。19%的患者存在合并症，其中73%接受了脊髓麻醉。在全身麻醉下分娩的新生儿出生时出现呼吸困难的更多（p = 0.002），入住新生儿病房的也更多（p = 0.031）。
麻醉方式的选择取决于手术的紧急程度和产妇的身体状况。全身麻醉更有可能用于出血性紧急情况和胎儿窘迫。脊髓麻醉更适用于择期和紧急病例或产妇存在疾病的情况。
