McMorland G H, Jenkins L C, Douglas M J
Can Anaesth Soc J. 1986 Mar;33(2):185-94. doi: 10.1007/BF03010830.
Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. There was also in community hospitals a significant incidence of failure to follow certain accepted safe practices (in obstetric patients), such as preinduction hydration and oxygenation, cricoid pressure during intubation and prevention of aortocaval compression. However, administration of general anaesthesia without endotracheal intubation, was rare in this survey. Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals.
通过问卷调查对不列颠哥伦比亚省的医院和麻醉医生进行了调查，以评估产科麻醉实践模式、产科麻醉人员的资质和数量、医院产科设施以及新生儿复苏的设施和方案。显然，该省很大一部分产科麻醉服务是由未经麻醉专科培训和认证的医生提供的。产科病房的麻醉前评估在态度和实践上与普通手术室的预期标准不同。在社区医院，也有相当比例的情况未遵循某些公认的安全做法（针对产科患者），例如诱导前补液和给氧、插管时环状软骨压迫以及预防主动脉腔静脉受压。然而，在本次调查中，未进行气管插管的全身麻醉情况很少见。产科病房的麻醉后恢复设施明显不足，即使在较大的医院也是如此。大多数社区医院缺乏新生儿复苏的书面方案；而且有相当数量的机构报告称未常规监测新生儿心率和体温，这令人担忧。建议明确界定产科麻醉培训的最低标准；并应为在较小社区医院执业的麻醉医生提供知识和技能的更新与提升。
