Gibbs C P, Krischer J, Peckham B M, Sharp H, Kirschbaum T H
Anesthesiology. 1986 Sep;65(3):298-306.
To assess obstetric anesthesia in the United States, and to determine why more anesthesia personnel are not involved in this subspecialty, a questionnaire was sent to the heads of obstetric and anesthesia services in 1,200 hospitals. Both obstetric and anesthesia respondents agreed on several characteristics of obstetric anesthesia that inhibit more participation by anesthesia personnel. Among others, they identified that: the unpredictability of labor and delivery makes scheduling difficult; obstetricians tend to dictate type and timing of anesthesia; the risk of malpractice claims is increased for obstetric anesthesia; and, finally, larger obstetric services would make it more practical to provide anesthesia services. Regarding availability of personnel and procedures, obstetric units with less than 500 deliveries per year were considerably more under-staffed than the larger units in most areas studied. When general anesthesia was used for cesarean section in these units, it was provided by, or given under the direction of, an anesthesiologist only 44% of the time, whereas in the hospitals with more than 1,500 deliveries per year, an anesthesiologist was present 86% of the time. Likewise, in the small units, personnel classified as "others" were responsible for newborn resuscitation in 24% and 43% of instances after cesarean section and vaginal delivery, respectively. In the hospitals with more than 1,500 deliveries, comparable figures were 4% and 2%, respectively.
为评估美国产科麻醉的情况，并确定为何没有更多麻醉专业人员参与这一亚专业领域，向1200家医院的产科和麻醉科负责人发送了一份调查问卷。产科和麻醉科的受访者都认同产科麻醉的几个特点，这些特点阻碍了麻醉专业人员更多地参与其中。其中，他们指出：分娩过程的不可预测性使得排班困难；产科医生往往决定麻醉的类型和时机；产科麻醉的医疗事故索赔风险增加；最后，规模较大的产科服务机构提供麻醉服务会更具可行性。关于人员配备和操作流程的情况，在大多数研究地区，年分娩量少于500例的产科单位人员配备明显比规模较大的单位不足。在这些单位进行剖宫产采用全身麻醉时，只有44%的情况是由麻醉医生提供或在其指导下进行，而在年分娩量超过1500例的医院，麻醉医生在场的比例为86%。同样，在小单位，分别有24%和43%的剖宫产和阴道分娩后的新生儿复苏由“其他人员”负责。在年分娩量超过1500例的医院，相应的数字分别为4%和2%。
