Where there is no anaesthetist: the role of obstetrician - administered spinal anaesthesia for emergency caesarean section

Abstract

Context: Shortage of anaesthetic manpower is a stark reality in developing countries like Nigeria where “waiting for the anaesthetist” has been repeatedly identified as a cause of phase 3 delays. This has led to widespread abuse of ketamine anaesthesia for emergency caesarean section in private hospital settings.
Objectives: To determine the effect of single handed obstetrician-anesthetist administered spinal anesthesia for caesarean section on Decision-Delivery Interval (DDI), postoperative hospital stay, fetal and maternal outcome.
Materials and Methods: A prospective analytical study comparing caesarean DDI between 42 consecutive emergency caesarean sections (CS) under Obstetrician-administered Spinal anesthesia (OASA) versus 42 women who had locum anesthetist administered spinal anesthesia (LAASA) and an equal number who had ketamine anesthesia.
Results: The DDI was about 2.5 fold shorter in the OASA (59.67 ± 9.40 minutes) compared with the LAASA (144.54 ± 28.00 minutes) group (pConclusion: Obstetrician-administered Spinal Anesthesia for emergency caesarean section reduces Decision-Delivery Interval and postoperative hospital stay. It is therefore judicious where there is no anesthetist. Moreover, it is superior to ketamine anesthesia for caesarean section.

Keywords: Obstetric anaesthesia, Spinal anaesthesia, Caesarean section, Bupivacaine, Ketamine

Trop J Obstet Gynaecol, 30 (1), April 2013