A survey of obstetric anaesthesia practice in British Columbia.

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.