Cross D A
Department of Anesthesiology, University of South Alabama Medical Center, Mobile 36617.
South Med J. 1993 Jan;86(1):33-7. doi: 10.1097/00007611-199301000-00008.
When the American Society of Anesthesiologists published its Guidelines for Regional Anesthesia in Obstetrics, I did a survey to determine what impact a broadly implemented strict interpretation of those guidelines might have on obstetric anesthesia care in small rural Alabama hospitals. Thirty-six rural Alabama hospitals with fewer than 200 beds were included in the survey, with a response rate of 50%. Data included total deliveries, cesarean section rates, utilization rates of anesthesia services, personnel providing anesthesia care, and identification of physician personnel available during labor and cesarean section. Results showed that anesthesia care is provided for approximately 52% of births in the responding hospitals. Of these, approximately 60% of cesarean sections and 90% of vaginal deliveries are not routinely attended by anesthesiologists. If these data also reflect the nonrespondent hospitals, statewide access could be limited for approximately 6000 parturients annually. The Guidelines should be interpreted with caution. Rather than conform to related policies, interpretation should allow implementation consistent with the capabilities of the individual institutions, while ensuring quality anesthesia care for the parturients.
当美国麻醉医师协会发布其《产科区域麻醉指南》时，我进行了一项调查，以确定广泛实施对这些指南的严格解释可能会对阿拉巴马州农村地区的小型医院的产科麻醉护理产生何种影响。该调查纳入了阿拉巴马州36家床位少于200张的农村医院，回复率为50%。数据包括总分娩量、剖宫产率、麻醉服务利用率、提供麻醉护理的人员，以及分娩和剖宫产期间可用的医师人员的识别信息。结果显示，在回复调查的医院中，约52%的分娩接受了麻醉护理。其中，约60%的剖宫产和90%的阴道分娩通常没有麻醉医师在场。如果这些数据也反映了未回复调查的医院的情况，那么该州每年约6000名产妇获得麻醉服务的机会可能会受到限制。对这些指南的解释应谨慎。与其遵循相关政策，不如根据各机构的能力进行解释，以确保在为产妇提供优质麻醉护理的同时，实现指南的实施。
