Abstract
Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.
Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists’ Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.
Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.
Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.
Résumé
Objectif: Décrire l’anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d’experts et proposer des sujets de recherches ultérieures.
Méthode: En 1997, un questionnaire détaillé sur la pratique de l’anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n’avaient pas encore répondu.
Résultats: Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d’anesthésiologistes pratiquant l’anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d’autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes: 1) l’information fournie pour obtenir le consentement à l’analgésie épidurale pendant le travail, 2) l’usage d’opioïdes et d’anesthésiques locaux pour amorcer l’analgésie épidurale, 3) l’utilisation d’épreuve de coagulation en prééclampsie, 4) l’usage courant d’aiguilles rachidiennes tranchantes, 5) l’administration neuraxiale de morphine et l’usage d’anti-inflammatoires non stéroïdiens après la césarienne, 6) le traitement optimal des effets secondaires de l’opioïde neuraxial, 7) le moment d’insertion d’une tube endotrachéal pour l’anesthésie générale après l’accouchement et 8) le retrait des cathéters épiduraux au travers de l’agiuille épidurale.
Conclusion: Cette enquête présente des données de référence sur la pratique de l’anesthésie obstétricale au Canada en 1997. Les anesthésiologistes affiliés ou non à une université ont une pratique très similaire.
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This study was supported by a grant from the Obstetric Section of the Canadian Anaesthetists’ Society.
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Breen, T.W., McNeil, T. & Dierenfield, L. Obstetric anesthesia practice in Canada. Can J Anesth 47, 1230–1242 (2000). https://doi.org/10.1007/BF03019874
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DOI: https://doi.org/10.1007/BF03019874