Anesthesia for Cesarean Delivery in a Low-Resource Setting, an Initial Review

DOI: 10.4236/ojanes.2014.49031   PDF   HTML     2,725 Downloads   3,532 Views   Citations

Abstract

Background: Bearing in mind the recent advances in obstetric anesthesia, the safety of both mother and child is of paramount importance, especially in a setting where resources are limited. We set out to find the pattern of cases presenting for cesarean delivery and the types of anesthesias provided for the management of these patients. Methods: A retrospective survey was conducted involving all anesthetics provided for cesarean delivery from January 2006 to December 2009 in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information such as age, indications and anesthetic technique, including drugs used, were extracted from patients’ records. Data were subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 17.0. Results: There were a total of 577 anaesthetics conducted for cesarean delivery during the period under review out of 4277 live births, giving a cesarean delivery rate of 13.5%. General anesthesia (GA) was administered on 266 (46%) of these patients, while 279 (48%) cases were done under subarachnoid block(SAB). 16 (3%) patients had combined GA and SAB, while 16 (3%) patients received epidural anesthesia. There were 302 emergency cesarean deliveries out of 577 cases, giving an emergency cesarean delivery rate of 52%. The commonest indication for cesarean delivery was two previous cesarean deliveries. Conclusion: A large percentage of our obstetric cases are being done under general anesthesia. Though majority of the conducted regional anesthesia were spinals (SAB), only a few cases were done under epidural block. Subspecialty training of anesthetists will go a long way to improve the current trends.

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Ogboli-Nwasor, E. and Yunus, A. (2014) Anesthesia for Cesarean Delivery in a Low-Resource Setting, an Initial Review. Open Journal of Anesthesiology, 4, 217-222. doi: 10.4236/ojanes.2014.49031.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Incerpi, M.H. (2007) Operative Delivery. In: Decherney, A.H., Nathan, L., Goodwin, T.M. and Laufer, N., Eds., Current Diagnosis and Treatment Obstetrics and Gynaecology, McGraw Hill, New York, 461-476.
[2] Jaiyesinmi, R.A. and Ojo, O. (2003) Caesarean Section. In: Okonofua, F. and Odunsi, K., Eds., Contemporary Obstetrics and Gynaecology for Developing Countries, Women’s Health and Action Research Centre, Benin City, 592-621.
[3] Megafu, U. and Nweke, P.C. (1991) Maternal Mortality from Caesarean Section. Tropical Journal of Obstetrics and Gynaecology, 9, 1-4.
[4] Swende, T.Z., Agida, E.T. and Jogo, A.A. (2007) Elective Caesarean Section at the Federal Medical Centre Makurdi, North-Central Nigeria. Nigerian Medical Journal, 16, 372-374.
[5] Sule, S.T. and Matawal, B.I. (2003) Comparisons of Indications for Caesarean Section in Zaria, Nigeria: 1985 and 1995. Annals of African Medicine, 2, 77-79.
[6] Mutihir, J.T., Daru, P.H. and Ujah, I.O. (2005) Elective Caesarean Section at Jos University Teaching Hospital. Tropical Journal of Obstetrics and Gynaecology, 22, 39-41.
[7] Nwobodo, E.I. and Wara, H.L. (2004) High Caesarean Section Rate at Federal Medical Centre, Birnin-Kebbi: Real or Apparent? Nigerian Medical Practitioner, 46, 39-40.
http://dx.doi.org/10.4314/nmp.v46i2.28724
[8] Department of Obstetrics and Gynaecology Statistics, Ahmadu Bello University Teaching Hospital. (2011) Unpublished Data.
[9] Shehu, D.J. (1992) Socio-Cultural Factors in the Causation of Maternal Morbidity and Mortality in Sokoto. In: Kisekka, M., Ed., Women’s Health Issues in Nigeria, Tamaza Publishing Company Limited, Zaria, 203-214.
[10] Korula, M. (2006) The High-Risk Obstetric Patient—Anaesthetic Implications. The Indian Anaesthetists Forum. Online ISSN 0973-0311.
http://www.theiaforum.org/article/
[11] Birnbach, D.J. and Browne, I.M. (2009) Anesthesia for Obstetrics. In: Miller, R.D., Eriksson, L.I., Fleisher, L.A., Wiener-kronish, J.P. and Young, W.L., Eds., Miller’s Anesthesia, 7th Edition, Churchill Livingstone, Edinburg, 2203-2210.
[12] http://data.worldbank.org/news/newest-country-classifications-released accessed 20/08/14
[13] Igberase, G.O., Ebeigbe, P.N. and Andrew, B.O. (2009) High Caesarean Section Rate: A Ten Year Experience in a Tertiary Hospital in the Niger Delta, Nigeria. Nigerian Journal of Clinical Practice, 12, 294-297.
[14] Ojiyi, E., Dike, E., Anolue, F. and Chukwulebe, A. (2012) Appraisal of Caesarean Section at the Imo State University Teaching Hospital, Orlu, Southeastern Nigeria. The Internet Journal of Gynecology and Obstetrics, 16, No. 2.
[15] Hamilton, B.E., Martin, J.A., Ventura, S.J., et al. (2005) Births: Preliminary Data for 2004. National Vital Statistics Reports, 54, 1-17.
[16] Depp, R. (1991) Cesarean Delivery and Other Surgical Procedures. In: Gabbe, S.G., Niebyl, J.R. and Simpson, J.L., Eds., Obstetrics: Normal and Problem Pregnancies, Churchill Livingstone, New York, 635.
[17] Braveman, F.R., Scavone, B.M., Wong, C.A. and Santos, A.C. (2009) Obstetrical Anesthesia. In: Barash, P.G., Cullen, B.F., Stoelting, R.K., Cahalan, M.K. and Stock, M.C., Eds., Clinical Anesthesia, Lippincott Williams & Wilkins, Philadelphia, 1137-1170.
[18] Schnittger, T. (2007) Regional Anaesthesia in Developing Countries. Anaesthesia, 62, 44-47.
http://dx.doi.org/10.1111/j.1365-2044.2007.05297.x
[19] Afolabi, B.B., Lesi, A.F.E. and Merah, N.A. (2006) Regional versus General Anaesthesia for Caesarean Section. Cochrane Database of Systematic Reviews, 10. http://dx.doi.org/10.1002/14651858.CD004350.pub2
[20] Eshiet, A.I., Udoma, E.J., Ekanem, A.D. and Dada, A. (2003) Effect of Anaesthesia on Morbidity and Mortality in Emergency Caesarean Section Patients in Calabar, Nigeria. Nigerian Journal of Physiological Sciences, 18, 77-81.
[21] Okafor, U.V., Ezegwui, H.U. and Ekwazi, K. (2009) Trends of Different Forms of Anaesthesia for Caesarean Section in South-Eastern Nigeria. Journal of Obstetrics & Gynaecology, 29, 392-395.
http://dx.doi.org/10.1080/01443610902932390
[22] Riley, E.T., Cohen, S.E., Macario, A., et al. (1995) Spinal versus Epidural Anesthesia for Cesarean Section: A Comparison of Time Efficiency, Costs, Charges and Complications. Anesthesia and Analgesia, 80, 709-712.
[23] Desalu, I. and Afolabi, B.B. (2007) Urgency of Surgery and Presence of Maternal Disease Influence the Choice of Anaesthesia for Caesarean Section at LUTH. The Nigerian Postgraduate Medical Journal, 14, 114-117.

  
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