A survey of obstetric anesthesia practices in district level and government teaching hospitals in Punjab, Pakistan
Abstract
Objectives: Maternal mortality rate remains unacceptably high in Pakistan. Nearly 200 women die in Pakistan for every 100000 live births as compared to 8 in Europe. According to Pakistan Demographic and Health Survey (PDHS) 2006-2007, anesthesia is one of the contributing factors to this high mortality rate. The aim of this survey was to find out what standards and guidelines in obstetric anesthesia are followed by anesthesiologists in teaching and district hospitals in Punjab, which is the largest province of Pakistan.
Methodology: From January 2016 to March 2016, seventeen teaching hospitals and twenty-four district hospitals in Punjab were asked to take part in telephonic or face-to-face survey. Questions were asked regarding the availability of internationally acceptable guidelines and protocols for managing obstetric emergencies like massive hemorrhage and failed intubation. Questions were also asked about the availability of equipment for difficult airway, blood products and regional anesthetic techniques used for cesarean sections. Data were collected in Microsoft Excel format and analyzed using simple statistics
Results: Overall availability of guidelines was lowest for massive hemorrhage (12%) and highest for managing difficult intubation (29%). For the management of difficult airway only 36% had endotracheal tube introducers. For major obstetric hemorrhage, 68% of the hospitals could get blood in 30 min and 24% could get fresh frozen plasma (FFP) in 30 min. Regional anesthesia was the preferred technique in all the government hospitals. For performing spinal anesthesia all of the anesthesiologists used sterile gloves while 51% used masks and gowns and only 39% washed their hands before spinal. Sensation of pain and leg raising were the main modalities used to test the spinal block with 41% anesthesiologists considering block up to T8 a good level to start cesarean section. 85% anesthesiologists used 25G Quincke spinal needle.
Conclusion: Our survey showed a grim state of affairs as far as obstetric anesthesia in government hospitals of Punjab is concerned however; a comprehensive survey is needed to draw final conclusions and make further recommendations
