Abstract
Anaesthesia for Caesarean sections performed during 1982–83 at the Women’s Hospital in Kathmandu, Nepal is reviewed, In a twelve-month period 535 Caesarean sections were performed, representing 7.36 per cent of 7,263 deliveries. Many pregnant women in Nepal do not have antenatal care and the mean haemoglobin of these mothers was 86g·L−1. In the absence of an on-call anaesthetist for obstetrics, more than 90 per cent of the anaesthetics were given by junior obstetric residents, using open drop diethyl ether without endotracheal intubation. Eleven patients developed postoperative chest infection; in none of these was there any suggestion of inhalation of gastric contents and all recovered uneventfully. Of the 18 maternal deaths in the 7, 263 delivereies during this period, one occurred during Caesarean section. This was due to uncontrollable haemorrhage and was not attributable to the anaesthetic. For poor risk patients, and in unskilled hands, diethyl ether remains a remarkably safe anaesthetic.
Résumé
L’anesthésie pour césarienne accomplie en 1982–83 à l’hôital “Women’s Hospital”, Kathmandu, Nepal, est revue. Pour une durée de douze mois, 535 césariennes ont été accomplies représentant 7.36 pour cent des 7,263 accouchements. P lusieurs des femmes enceintes du Nepal n’ont pas reçu de soins prénataux et l’hémoglobine moyenne de ces mères était de 86 g·L−1. En l’absence du’un anesthésiste de garde en obstérique, 90 pour cent et plus des anesthésies ont été données par le résident junior en obstétrique utilisant le diéthyl éther en goutte d’ un circuit ouvert sans intubation endotrachéale. Onze patientes ont développé une infection pulmonaire post-opératoire; chez aucune de ces patientes il n’y avait dés évidence d’aspiration bronchique et tautes se sont rétablies sans conséquence. Des 18 morts maternelles pour 7,263 accouchements pendant cette période, une est survenue lors d’une césarienne. Celle-ci était due à une hémorragie incontrôlable et non attributée à l’anesthésie. Pour des patientes à pauvre risque et duns des mains non expertes, le diéthyl éther demeure un anesthésique remarquablement sécuritaire.
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Maltby, J.R., Malla, D.S. & Dangol, H. Open drop ether anaesthesis for Caesarean section: a review of 420 cases in Nepal. Can Anaesth Soc J 33, 651–656 (1986). https://doi.org/10.1007/BF03014272
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DOI: https://doi.org/10.1007/BF03014272