Stamer U M, Messerschmidt A, Wulf H
Department of Anaesthesiology, University of Bonn, Germany.
Acta Anaesthesiol Scand. 1998 Jul;42(6):678-84. doi: 10.1111/j.1399-6576.1998.tb05301.x.
Anaesthetic practice for caesarean section has changed during the last decades. There is a world-wide shift in obstetric anaesthetic practice in favour of regional anaesthesia. Current data concerning anaesthetic practice in patients undergoing caesarean section from Germany are not available. A comparison with figures from the UK, USA, Norway and other European countries might be of general interest.
Questionnaires on the practice of anaesthesia for caesarean section and anaesthetic coverage of the obstetric units were sent to 1178 university, tertiary care, district, community and private hospitals in Germany.
The 532 completed replies of this survey represent 46.9% of the German obstetric units. Most hospitals (42.3%) have delivery rates between 500 and 1000 per year. General anaesthesia is the most common anaesthetic technique for elective (61%), urgent (83%) and emergency caesarean section (98%). Epidural anaesthesia is performed in 23% of scheduled and 5% of non-scheduled caesarean sections, and spinal anaesthesia in 14% and 10% respectively. Acid aspiration prophylaxis before elective caesarean section is used in 68.7% of the departments. The majority of the departments provide a 24-hour anaesthetic coverage; however, in only 6.2% of the units, this service is assigned to obstetric anaesthesia, exclusively.
Compared to data from 1978, anaesthetic practice for caesarean section has changed with an increase in regional anaesthesia. However, German anaesthetists prefer general anaesthesia for caesarean section. In contrast, anaesthetists in other countries predominantly use regional techniques, and the difference to German practice is striking. International consensus discussion and recommendations as well as comparable European instruments of quality control in obstetric anaesthesia are desirable.
在过去几十年中，剖宫产的麻醉方式发生了变化。全球产科麻醉实践正向区域麻醉转变。目前尚无来自德国的剖宫产患者麻醉实践的相关数据。与英国、美国、挪威及其他欧洲国家的数据进行比较可能会引起广泛关注。
向德国的1178家大学医院、三级医疗机构、地区医院、社区医院和私立医院发送了关于剖宫产麻醉实践及产科单位麻醉覆盖情况的调查问卷。
本次调查共收到532份完整回复，占德国产科单位的46.9%。大多数医院（42.3%）每年的分娩率在500至1000例之间。全身麻醉是择期剖宫产（61%）、急诊剖宫产（83%）和紧急剖宫产（98%）最常用的麻醉技术。硬膜外麻醉在23%的择期剖宫产和5%的非择期剖宫产中使用，脊髓麻醉分别为14%和10%。68.7%的科室在择期剖宫产术前采用了预防胃酸误吸的措施。大多数科室提供24小时麻醉服务；然而，只有6.2%的单位将此项服务专门分配给产科麻醉。
与1978年的数据相比，剖宫产的麻醉方式发生了变化，区域麻醉有所增加。然而，德国麻醉医生在剖宫产时更倾向于全身麻醉。相比之下，其他国家的麻醉医生主要采用区域麻醉技术，与德国的做法差异显著。产科麻醉方面需要进行国际共识讨论并提出建议，以及建立类似的欧洲质量控制标准。
