G A Albright1, R M Forster. 1. Department of Anesthesiology, Bellevue Woman's Hospital, Niskayuna, New York, USA.
Abstract
BACKGROUND AND OBJECTIVES: This study examined the safety and efficacy of combined spinal and epidural (CSE) analgesia/anesthesia performed in a community hospital. METHODS: Labor and Surgical Anesthesia Quality Assessment Worksheets were completed by the responsible anesthesiologist for 7,893 general anesthetics and 7,931 regional anesthetics from January 1, 1994 to December 31, 1997. A retrospective computerized analysis of these data tabulated the number of regional anesthesia techniques and identified anesthesia effectiveness and complications associated with these procedures. The safety and efficacy of CSE analgesia/anesthesia (6,002 blocks) was assessed by comparing these results with reported complications and failure rates for spinal and epidural anesthesia. RESULTS: The CSE technique did not increase the risk of anesthesia complications, as compared with the reported prevalence associated with major regional anesthesia. It provided decreased failure rates for labor analgesia and comparable or decreased failure rates for surgical anesthesia, when compared with reported failure rates for epidural anesthesia. Apnea did not occur in parturients who received 4,164 CSE blocks with intrathecal sufentanil (ITS; 10, 15, or 20 microg) for labor pain relief. However, the prevalence of laboring patients requiring intravenous medication for side effects was related to the dose of ITS: 10 microg (1.1%), 15 microg (4.6%), and 20 microg (5.5%) (P < .001). Patients who received prior systemic narcotics less than 6 hours before ITS were twice as likely to require intravenous treatment for low oxygen saturation/drowsiness (21%) than were those who experienced dysphagia or pruritus (10%) (P < .001). CONCLUSIONS: This review of 6,002 CSE blocks performed in a community hospital has demonstrated that CSE labor analgesia, surgical anesthesia are safe and efficacious. We believe that patient observation and continuous pulse oximetry for 1-2 hours after administration of ITS and prompt treatment with intravenous naloxone for severe drowsiness, low oxygen saturation (PaO2 < 90% unresponsive to mask oxygen), or dysphagia should be used to minimize the risk of apnea.
BACKGROUND AND OBJECTIVES: This study examined the safety and efficacy of combined spinal and epidural (CSE) analgesia/anesthesia performed in a community hospital. METHODS: Labor and Surgical Anesthesia Quality Assessment Worksheets were completed by the responsible anesthesiologist for 7,893 general anesthetics and 7,931 regional anesthetics from January 1, 1994 to December 31, 1997. A retrospective computerized analysis of these data tabulated the number of regional anesthesia techniques and identified anesthesia effectiveness and complications associated with these procedures. The safety and efficacy of CSE analgesia/anesthesia (6,002 blocks) was assessed by comparing these results with reported complications and failure rates for spinal and epidural anesthesia. RESULTS: The CSE technique did not increase the risk of anesthesia complications, as compared with the reported prevalence associated with major regional anesthesia. It provided decreased failure rates for labor analgesia and comparable or decreased failure rates for surgical anesthesia, when compared with reported failure rates for epidural anesthesia. Apnea did not occur in parturients who received 4,164 CSE blocks with intrathecal sufentanil (ITS; 10, 15, or 20 microg) for labor pain relief. However, the prevalence of laboring patients requiring intravenous medication for side effects was related to the dose of ITS: 10 microg (1.1%), 15 microg (4.6%), and 20 microg (5.5%) (P < .001). Patients who received prior systemic narcotics less than 6 hours before ITS were twice as likely to require intravenous treatment for low oxygen saturation/drowsiness (21%) than were those who experienced dysphagia or pruritus (10%) (P < .001). CONCLUSIONS: This review of 6,002 CSE blocks performed in a community hospital has demonstrated that CSE labor analgesia, surgical anesthesia are safe and efficacious. We believe that patient observation and continuous pulse oximetry for 1-2 hours after administration of ITS and prompt treatment with intravenous naloxone for severe drowsiness, low oxygen saturation (PaO2 < 90% unresponsive to mask oxygen), or dysphagia should be used to minimize the risk of apnea.