Background and objective: It is not known whether anaesthetic practices for ASA I parturients undergoing scheduled caesarean delivery have changed since the last (1996) survey and how practices reflect current recommendations.
Methods: A 26-item survey questionnaire (organization of the maternity unit, preoperative evaluation, technical aspects describing regional or general anaesthesia, oxytocic and antibiotic drugs, postoperative analgesia) was distributed to all French obstetric units (excluding overseas).
Results: The response rate was 73% (451/621). Preoperative evaluation included a recent platelet count in 97% of responding units, and information was given to patients in 84% of cases. Antibiotic prophylaxis in accordance with French guidelines was used in 78% of units. Anaesthetic techniques were single-shot spinal, epidural, combined spinal epidural and general anaesthesia in decreasing order (92.5, 4.5, 2 and 1%, respectively). Effervescent cimetidine was the first choice in 62% of units. Cricoid pressure and succinylcholine were routinely used in 66 and 77% of units, respectively. Oxytocin was used appropriately in 65% of units. In addition to spinal or epidural opioids, paracetamol, NSAIDs and nefopam were added postoperatively in 98, 68 and 19% of units, respectively. Poorer practices were found in units having a lower annual delivery rate.
Conclusions: Overall practice was in accordance with national guidelines or practice patterns defined by the expert committee. Regional anaesthesia and postoperative analgesia-related techniques particularly were adequate. Some deficits were of limited importance (antibiotic prophylaxis and oxytocin administration), whereas others (use of succinylcholine and cricoid pressure) remain of concern.
aAP-HP, Service d'Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
bService d'Anesthésie-Réanimation Chirurgicale, Hôpital Central, Nancy, France
cService d'Anesthésie-Réanimation, Hôpital mère-enfant, Université Claude Bernard, Lyon, France
dRéseau Ombrel, Clinique Cotteel, Villeneuve d'Ascq, France
ePôle Anesthésie et Réanimation, Unité d'Anesthésie Obstétricale et Pédiatrique, GRCB 48, IFR 31, Toulouse, France
fDépartement d'Anesthésie-Réanimation, Université François Rabelais, Faculté de Médecine de Tours, Tours, France
gAP-HP, Département d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Clamart, France
hDépartement d'Anesthésie-Réanimation, Hôpital de l'Archet 2, Nice, France
Correspondence to Professor Dan Benhamou, Service d'Anesthésie-Réanimation, Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France Tel: +33 1 45 21 34 47; fax: +33 1 45 21 28 75; e-mail: firstname.lastname@example.org
Presented in abstract form at the 2005 meeting of the French National Society of Anaesthesia and Intensive Care