Hawkins J L, Gibbs C P, Orleans M, Martin-Salvaj G, Beaty B
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, USA.
Anesthesiology. 1997 Jul;87(1):135-43. doi: 10.1097/00000542-199707000-00018.
In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations.
Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology.
Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981.
Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.
1981年，在美国麻醉医师协会和美国妇产科医师学会的支持下，对麻醉科和产科医护人员进行了调查，以确定美国提供产科麻醉的人员和方法。1992年，在相同组织的支持下，该调查得以扩展并重复进行。
美国麻醉医师协会产科麻醉委员会和美国妇产科医师学会产科实践委员会的意见和问题被添加到原始调查问卷中，以纳入新出现的问题，同时便于与1981年的数据进行比较。利用美国医院协会的医院登记信息，根据每年的分娩数量（第一层，≥1500例分娩；第二层，500 - 1499例分娩；第三层，＜500例分娩）以及美国人口普查区域对医院进行区分。选取了医院的分层随机样本。向每家医院的管理人员发送两份调查问卷，一份给产科主任，一份给麻醉科主任。
与1981年的数据相比，提供产科护理的医院数量总体减少（从4163家降至3545家），减少主要发生在规模最小的医院（1981年第三层医院中有56%，1992年为45%）。更多女性接受了某种形式的分娩镇痛，硬膜外镇痛的使用增加了100%。然而，20%规模最小的医院无法提供区域镇痛。4%的产妇使用了分娩脊髓镇痛。1981年，产科医生提供了30%的分娩硬膜外镇痛；1992年他们仅提供了2%。剖宫产患者中有78 - 85%（取决于分层）使用了区域麻醉，导致全身麻醉使用显著减少。仅4%的第一层医院由护士麻醉师在无麻醉医师医疗指导的情况下提供剖宫产麻醉，但在第三层医院中这一比例为59%。10%的剖宫产分娩中麻醉人员参与了新生儿复苏，而1981年这一比例为23%。
与1981年相比，产妇在分娩期间更常使用镇痛，剖宫产患者中全身麻醉使用较少。在规模最小的医院，许多产妇仍无法获得分娩区域镇痛，超过一半的剖宫产麻醉由护士麻醉师在无麻醉医师医疗指导的情况下提供。产科医生为患者亲自提供硬膜外镇痛的可能性降低。麻醉人员参与新生儿复苏的情况减少。
