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A survey of obstetrical anaesthesia practice, teaching and research in canadian university departments of anaesthesia

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Abstract

A report is presented of a questionnaire survey of obstetrical anaesthesia practice patterns, academic structure, resident teaching and research programmes in Canadian University Departments of Anaesthesia. Replies were received from 13 of the 16 departments, representing 24 university-affiliated hospitals.

It is apparent that the majority of these hospitals do not have adequate obstetrical anaesthesia coverage. In most instances the delivery suite is covered by the anaesthetists on duty in the operating rooms. While epidural analgesia is widely used during labour, there are some hospitals where it still has a limited use, or is not used at all. Caesarean sections are still largely done under general anaesthesia in most reporting hospitals, with a few institutions reporting an increasing use of regional (mainly epidural) anaesthesia.

Resident training in this branch of anaesthesia is felt to be deficient, based on the reports from many hospitals that resident staff are frequently not in attendance at deliveries; and on the evident failure in the majority of institutions to utilize their clinical material for teaching purposes.

Research programmes in obstetrical anaesthesia are rare. The most common reason cited was the difficulty experienced in obtaining research funds.

It is suggested that the major problems in obstetrical anaesthesia service, teaching and research are:

  1. 1.

    Economic,

  2. 2.

    Lack of interest, and

  3. 3.

    Lack of manpower.

It is recommended that consideration be given to:

  1. 1.

    Consolidation of obstetrical services into larger units wherever practical.

  2. 2.

    Creation of more geographic full time appointments in obstetrical anaesthesia.

  3. 3.

    More efficient use of clinical material for teaching.

  4. 4.

    Development in individual hospitals of prenatal and public education programmes.

Résumé

Les auteurs présentent les résultats ďune enquête effectuée par correspondance portant sur les modalités ďexercice de ľanesthésie obstétricale, de sa structure académique, des programmes de résidence et de recherche dans les départements universitaires ďanesthésie. Treize des seize départements universitaire représantant 24 hôpitaux ďaffiliation universitaire ont rempli le questionnaire.

Il semble que la majorité de ces hôpitaux ne bénéficie pas de service ďanesthésie obstétricale efficace. Dans la plupart de cas, la salle ďaccouchement est sous la responsabilité de ľanesthésiste de garde en chirurgie. Bien que ľanalgésie péridurale soit en général assez répandue, il y a encore des hôpitaux où elle est peu ou pas utilisée. La césarienne se fait encore en grande partie sous anesthésie générale dans la plupart des hôpitaux répondant alors que certains établissements rapportent une augmentation de fréquence de ľutilisation de ľanesthésie régionale, plus particulièrement de la péridurale.

Ľenseignement aux résidents est considéré comme déficient dans cette discipline de ľanesthésie, si on s’appuie sur les rapports de plusieurs hôpitaux où les résidents n’assistent même pas aux accouchements et sur ľinsuccès évident de ľutilisation du matériel clinique dans un but éducatif dans la majorité des cas. La recherche en anesthésie obstétricale est un phénomène rare, à cause semble-t-il, de ľimpossibilité ďobtenir des subventions.

On en conclut que les problèmes majeurs de ľanesthésie obstétricale sous ľaspect de ľexercice, de la recherche et de ľenseignement résultent:

  1. 1.

    de problèmes économiques;

  2. 2.

    du manque ďintérêt;

  3. 3.

    du manque ďeffectifs.

Il est recommandé de donner de sérieuses considérations:

  1. 1.

    au regroupement dans des unités plus grandes;

  2. 2.

    à la création de plein temps géographiques en anesthésie obstétricale;

  3. 3.

    à une plus grande utilisation du matériel ďétudes;

  4. 4.

    au développement de programmes ďéducation publique dans certains hôpitaux.

References

  1. 1.

    Hicks, J.S., Levinson, G. &Shnider, S.M. Obstetric anaesthesia training centers in the U.S.A. — 1975. Anesth. Analg.55: 6, 839–845 (1976).

  2. 2.

    Alper, M.H. Anesthesia and perinatal care. Clinics in Perinatology. 3; 2, pp. 463–468 (1976).

  3. 3.

    City of New York Commissioner of Health — Recommended Standards for Obstetric Anesthesia Care (1974).

  4. 4.

    Towards improving the outcome of pregnancy: recommendations for regional development of maternal and perinatal health services. The National Foundation — March of Dimes. White Plains, New York (1976).

  5. 5.

    Marx, G.F. Personal communication (1977).

  6. 6.

    Churchill-Davidson, H.C. Introduction to Symposium on Obstetrical Analgesia and Anesthesia. Acta Anaesth. Scand. Suppl.25: 343 (1966).

  7. 7.

    Hehre, F.W. In public health aspects of critical care medicine and anesthesiology. Ed. Safar, P. Philadelphia, F.A. Davis Company.10: 3, 332 (1974).

  8. 8.

    Brackbill, Y., Kane, J., Maniello, R.L. &Abramson, D. Obstetrical premedication and infant outcome. Amer. J. Obstet. Gynec.118: 337–387 (1974).

  9. 9.

    American Academy of Pediatrics Committee on Drugs in collaboration with the American College of Obstetricians and Gynecologists. Committee on Obstetrics. Maternal and fetal medicine: effects of medication during labour and delivery on infant outcome. Pediatrics62: 402–403 (1978).

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Correspondence to Graham H. McMorland or Leonard C. Jenkins.

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McMorland, G.H., Jenkins, L.C. A survey of obstetrical anaesthesia practice, teaching and research in canadian university departments of anaesthesia. Canad. Anaesth. Soc. J. 27, 417–421 (1980). https://doi.org/10.1007/BF03007467

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Keywords

  • Vaginal Delivery
  • Epidural Analgesia
  • Caesarean Section Rate
  • Resident Training
  • Obstetrical Anaesthesia