Advertisement

Canadian Anaesthetists’ Society Journal

, Volume 7, Issue 3, pp 280–289 | Cite as

The routine use of lumbar epidural anaesthesia in obstetrics: A clinical review of 9,532 cases

  • S. M. Eisen
  • N. Rosen
  • H. Winesanker
  • K. Hellman
  • H. I. Axelrod
  • M. Rotenberg
  • A. Relle
  • E. Sheffman
Article

Summary

A report is given of an attempt by the anaesthetic staff of the New Mount Sinai Hospital, Toronto, to evaluate lumbar epidural anaesthesia as a routine anaesthetic in obstetrics. This was done primarily in order to eliminate the threat of maternal mortality through the aspiration of stomach contents. To anaesthetize all obstetrical patients in this manner it was necessary to obtain the full co-operation of the entire obstetrical, anaesthetic, and nursing staffs. It was also necessary to modify the technique of lumbar epidural anaesthesia so that the procedure takes only about three minutes. Surgical scrub of the hands and the donning of a sterile gown have been omitted from the technique, with no evidence of infection in the reported 9,532 obstetrical cases and 5,091 surgical cases. The classically dreaded complication of total spinal anaesthesia occurred four times or 0.42 per cent, and that of convulsions occurred six times or 0.63 per cent. All cases responded to therapy without apparent harm to mother or infant. Lesser complications occurred infrequently and have been discussed in the paper. There were no anaesthetic deaths in this series. Labour is apparently not slowed by epidural anaesthesia and dilatation of the cervix seems to be hastened.

After three years of this experiment, we now use lumbar epidural anaesthesia for over 90 per cent of our vaginal deliveries, and general anaesthesia for less than 5 per cent.

The obstetrical and anaesthetic staffs of our hospital believe that although lumbar epidural anaesthesia in obstetrics has some shortcomings it is the most desirable obstetrical anaesthetic available today.

Keywords

Spinal Anaesthesia Epidural Space CANADIAN Anaesthetist Inhalation Anaesthesia Dural Puncture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Le personnel du service ďanesthésie de ľhôpital New Mount Sinai, Toronto, présente le résultat ďune tentative ďappréciation de ľusage de routine de ľanesthésie épidurale lombaire en obstétrique. Le premier but de cette pratique a été ďéliminer la mortalité maternelle qui survient à la suite de regurgitation et ďaspiration bronchique du contenu gastrique. Pour réussir à administrer cette anesthésie à toutes les malades, il faut absolument être assuré de la collaboration de tout le personnel obstétrical, anesthésique ou infirmière. De plus, il a fallu modifier la technique anesthésique pour qu’elle ne dépasse pas trois minutes. Le brossage chirurgical des mains et la blouse stérile ont été laissés de côté et, sur 9532 cas ďobstétrique et 5091 cas de chirurgie, on ne nous a pas signalé ďinfection. La complication classique ďanesthésie rachidienne totale est survenue quatre fois soit 0.42% et celle de convulsions est survenue six fois soit 0.63%. La thérapeutique appliquée a été efficace et ni la mère ni ľenfant ne porte de sequelle. Des complications de moindre importance ont été observées de temps en temps, on les mentionne dans le travail. Dans cette série, aucune mort n’est survenue. Le travail, selon toute apparence, n’est pas ralenti par ľanesthésie épidurale et la dilatation du col semble accélérée.

Après avoir procédé de cette façon depuis trois ans, nous continuons à employer ľanesthésie épidurale dans 90% de nos accouchements vaginaux et nous employons ľanesthésie générale chez moins de 5% de nos cas.

Le personnel des deux services: ďobstétrique et ďanesthésie de notre hôpital s’accordent à dire que, bien que ľanesthésie épidurale en obstétrique aie quelques inconvénients, elle demeure ľanesthésie obstétricale la plus souhaitable à notre disposition aujourďhui.

References

  1. 1.
    Merrell, R. B., &Hingson, R. A. Study of Incidente of Maternal Mortality from Aspiration of Vomitus during Anesthesia Occurring in Major Obstetric Hospitals in United States. Anesth. & Analg.31: 121 (May-June, 1951).Google Scholar
  2. 2.
    Edwards, G.;Morton, H. I. V.;Pask, E. A.; &Wylie, W. D. Deaths Associated with Anaesthesia. Anaesthesia11: 194 (July, 1956).PubMedCrossRefGoogle Scholar
  3. 3.
    Hingson, R. A., &Hellman, I. H. Organization of Obstetrical Anesthesia on a 24 hr. Basis in a Large and a Small Hospital. Anesthesiology12: 745 (1951).PubMedCrossRefGoogle Scholar
  4. 4.
    Huston, J. W., &Lebhartz, T. B. Incidence of Post-Partum Headaches after Spinal Anaesthesia. Am. J. Obst. & Gynec.63: 139 (1952).Google Scholar
  5. 5.
    Vandam, L. D., &Dripps, R. D. Long Term Follow-up of Patients who Received 10,000 Spinal Anesthetics: Syndrome of Decreased Intra-Cranial Pressures. J.A.M.A.161: 586 (1956).Google Scholar
  6. 6.
    Gilbert, R. G. B. Neurological Complications of Spinal Anaesthesia. Canad. Anaesth. Soc. J.2: 116 (1955).CrossRefGoogle Scholar
  7. 7.
    Chaplin, R. A., &Renwick, W. A. Lumbar Epidural Anaesthesia for Vaginal Delivery. Canad. Anaesth. Soc. J.5: 414 (Oct., 1958).PubMedCrossRefGoogle Scholar
  8. 8.
    Fleming, S. A., &Campbell, S. M. Epidural Anesthesia in Obstetrics. Anesth. & Analg.30: 2 (March-April, 1958).Google Scholar
  9. 9.
    Bromage, P. R. Spinal Epidural Analgesia, 1st ed. Edinburgh and London: E. & S. Livingstone Ltd. (1954).Google Scholar
  10. 10.
    Moore, D. C. Complications of Regional Anesthesia, 1st ed. Springfield: Thomas (1955).Google Scholar
  11. 11.
    Bonica, John J.;Backup, Phillip, N.;Anderson, Charles E.;Hadfield, Dale; &Crepps, William F. Peridural Block: Analysis of 3,637 Cases and a Review. Anesthesiology18 (5) (Sept.-Oct., 1957).Google Scholar

Copyright information

© Canadian Anesthesiologists 1960

Authors and Affiliations

  • S. M. Eisen
    • 1
  • N. Rosen
    • 1
  • H. Winesanker
    • 1
  • K. Hellman
    • 1
  • H. I. Axelrod
    • 1
  • M. Rotenberg
    • 1
  • A. Relle
    • 1
  • E. Sheffman
    • 1
  1. 1.Department of AnaesthesiaNew Mount Sinai HospitalToronto

Personalised recommendations