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Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey

Benhamou, Dana; Bouaziz, Hervéb; Chassard, Dominiquec; Ducloy, Jean-Clauded; Fuzier, Valériee; Laffon, Marcf; Mercier, Frédéricg; Raucoules, March; Samii, Kamrane

European Journal of Anaesthesiology:
doi: 10.1097/EJA.0b013e328329b071
Original Articles - Obstetrics and Regionals
Abstract

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.

Author Information

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: dan.benhamou@bct.aphp.fr

Presented in abstract form at the 2005 meeting of the French National Society of Anaesthesia and Intensive Care

© 2009 European Society of Anaesthesiology