Basnet Smriti, Lekhak Prabineshwor Prasad, Subedi Prabin, Moktan Sushila Lama
Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2024 Sep;62(277):592-596. doi: 10.31729/jnma.8738. Epub 2024 Sep 30.
The global surge in cesarean deliveries necessitates safe anesthetic practices to optimize outcomes. While the neuraxial block is the preferred method, specific conditions warrant general anesthesia. This study is aimed to determine the prevalence of cesarean sections under general anesthesia at a tertiary care center.
A descriptive cross-sectional study was conducted on cesarean sections performed between April 14, 2013, and April 13, 2023, at a tertiary care center. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20092023/01). Total sampling was done. Data for the past ten years were manually collected from hospital records using a self-structured proforma and analyzed using Microsoft Excel 2018 and IBM SPSS version 26. The point estimate and 95% confidence interval were calculated for the study.
In this study, there were 216 (2.98%) (95% CI: 2.59-3.38%) cesarean sections under general anesthesia in 10 years. Notably, among them, there were 103 (47.69%) primigravida, nullipara 130 (60.19%), 135 (62.50%) with no living children, and 161 (74.54%) without any past abortions. In most cases, 182 (84.26%) were emergency procedures and 34 (15.74%) were elective. Fetal bradycardia with distress was the primary indication observed in 121 (56.02%) cases, followed by 32 (14.81%) maternal requests. Additionally, 21 (2.66%) cases were found initially planned as cesarean sections under subarachnoid block but were converted to general anesthesia. The prevalence in this study was found within the recommended limits.
The findings highlight that the majority of these procedures were emergency cases, predominantly due to fetal distress, with a notable proportion involving primigravida and nulliparous women.
全球剖宫产率的激增使得安全的麻醉操作成为优化分娩结局的必要条件。虽然神经阻滞是首选方法，但特定情况需要全身麻醉。本研究旨在确定某三级医疗中心全身麻醉下剖宫产的发生率。
对2013年4月14日至2023年4月13日在某三级医疗中心进行的剖宫产手术进行描述性横断面研究。获得了机构审查委员会的伦理批准（参考编号：20092023/01）。采用全样本抽样。使用自行设计的表格从医院记录中手动收集过去十年的数据，并使用Microsoft Excel 2018和IBM SPSS 26版进行分析。计算了该研究的点估计值和95%置信区间。
在本研究中，10年间有216例（2.98%）（95%CI：2.59 - 3.38%）剖宫产采用全身麻醉。值得注意的是，其中初产妇103例（47.69%），未产妇130例（60.19%），无存活子女者135例（62.50%），既往无流产史者161例（74.54%）。在大多数情况下，182例（84.26%）为急诊手术，34例（15.74%）为择期手术。胎儿窘迫伴心动过缓是121例（56.02%）病例中观察到的主要指征，其次是产妇要求32例（14.81%）。此外，发现21例（2.66%）最初计划在蛛网膜下腔阻滞下行剖宫产，但改为全身麻醉。本研究中的发生率在推荐范围内。
研究结果表明，这些手术大多数是急诊病例，主要原因是胎儿窘迫，其中初产妇和未产妇占相当比例。
