Department of Anaesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Anesthesiol. 2024 Apr 5;24(1):129. doi: 10.1186/s12871-024-02484-y.
Failed spinal anaesthesia causes prolonging of operation time, insufficient analgesia for surgery and needs repeating spinal anaesthesia which in turn causes local anaesthesia toxicity, high spinal and total spinal, and conversion to general anaesthesia. However, the problem remains unexplored in Amhara regional state comprehensive specialized hospitals.
To determine incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery in selected Amhara National Regional State comprehensive specialized hospitals, Northwest Ethiopia, 2023.
Multi-center prospective observational study was conducted. Data was collected using questionnaire and checklist. All consecutive scheduled emergency and elective patients were included in the study. Data was transformed from Epi data to SPSS and logistic regression analysis was done. Both crude and adjusted odds ratio were used to assess the strength of association. Variables with a p-value of less than 0.05 were considered as statistically significant.
A total of 532 patients were included in this study with a response rate of 98%. Incidence of failed spinal anaesthesia was 22.4% (CI = 19-25.9). Emergency surgery (AOR = 7.01, CI = 4.5-12.7), dose of bupivacaine of ≤ 10 mg (AOR = 3.02, CI = 1.3-10.2), work experience of anaesthetist < 2 years (AOR = 3.1, CI = 1.7-5.72), bloody CSF (AOR = 8.5, CI = 2.53-18.5), hyperbaric local anaesthetic drug (AOR = 3.3, 95% CI = 3.2-8.2) and local anaesthetist without adjuvants (AOR = 5.25, CI = 2.62-14.2) were associated failed spinal anaesthesia.
The incidence of failed spinal anaesthesia was high in Amhara Region comprehensive specialized hospitals. We suggest that anaesthesia providers should minimize failure by using adjuvants and appropriate dose of local anaesthetic. Additionally, simulation training should be given for anaesthesia trainees to improve their skills and to produce competent professionals.
脊髓麻醉失败会延长手术时间、导致手术时镇痛不足，并需要再次进行脊髓麻醉，从而导致局部麻醉毒性、高位脊髓麻醉和全脊髓麻醉，并转为全身麻醉。然而，在埃塞俄比亚阿姆哈拉地区州综合专科医院，这一问题仍未得到探讨。
在 2023 年，于埃塞俄比亚阿姆哈拉地区州综合专科医院调查手术患者中脊髓麻醉失败的发生率及相关因素。
采用多中心前瞻性观察性研究。使用问卷和检查表收集数据。所有连续的择期急诊和择期手术患者均纳入本研究。将数据从 EpiData 转换到 SPSS，并进行逻辑回归分析。使用粗比值比和调整比值比来评估关联强度。p 值小于 0.05 的变量被认为具有统计学意义。
本研究共纳入了 532 名患者，应答率为 98%。脊髓麻醉失败的发生率为 22.4%（95%CI=19-25.9）。急诊手术（优势比[OR] = 7.01，95%CI=4.5-12.7）、布比卡因剂量≤ 10mg（OR=3.02，95%CI=1.3-10.2）、麻醉医生工作经验<2 年（OR=3.1，95%CI=1.7-5.72）、血性脑脊液（OR=8.5，95%CI=2.53-18.5）、高比重局部麻醉药（OR=3.3，95%CI=3.2-8.2）和无辅助剂的局部麻醉师（OR=5.25，95%CI=2.62-14.2）与脊髓麻醉失败相关。
在阿姆哈拉地区综合专科医院，脊髓麻醉失败的发生率较高。我们建议麻醉提供者应通过使用辅助剂和适当剂量的局部麻醉药来尽量减少失败。此外，应向麻醉培训生提供模拟培训，以提高他们的技能并培养有能力的专业人员。
