Abstract
We reviewed the out-patient consultation notes of 136 pregnant women seen at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the efficiacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In addition, their anaesthetic records from labour and delivery were reviewed. For each patient the reason for referral was recorded according to the involved organ system. The anaesthetic management at delivery was compared with the proposed anaesthetic plan by the OAC consultant (obstetric anaesthetist). The majority of women 84 (62%) had complaints related to the musculo-skeletal system. In addition, 18 patients were referred because of previous anaesthetic problems, ten with a history of cardiac disease, and eight with neurological disease. Lumbar epidural analgesia (LEA) was a safe and effective choice for parturients with low back pain, history of lumbar fractures or single level discectomies without lumbar fusion. Parturients with posterior instrumentation experienced an increased incidence of inadequate pain relief from LEA. Individualized anaesthetic management plans were executed for parturients with spina bifida occulta, neurological, cardiac, and haematological disease as well as for women with a history of adverse drug reactions and previous problems with regional or general anaesthesia. It is concluded that the OAC has provided a valuable service to obstetricians and anaesthetists for the anaesthetic management of pregnant women with co-existing disease. The OAC gave an opportunity for patient education regarding anaesthetic options for labour and delivery. The attending anaesthetist was provided with a risk assessment and anaesthetic management plan which was adhered to with only two exceptions. Finally, the obstetrician was given consistent dvice regarding anaesthesia management that may affect obstetrical decisions.
Résumé
A l’hôpital civique d’Ottawa de 1985 à 1991, nous avons révisé les observations de 136 parturientes recueillies en clinique externe dans le but d’examiner l’efficacité de la clinique d’évaluation anesthésique obstétricale (CAO). Les dossiers du travail et de l’accouchement de ces patientes ont aussi été revus. Pour chacune des patientes la raison de la consultation a été classée selon le système mis en cause. La conduite anesthésique obstétricale a été comparée au plan projeté par le consultant de la CAO. Quatre-vingt quatre patientes (62%) avaient des symptômes se rapportant au système musculosquelettique. De plus 18 patientes ont été référées en raison de problèmes anesthésiques antérieurs dont dix avec des antécédents cardiaques et huit avec des antécédents neurologiques. L’anesthésie lombaire épidurale (ALE) a été un choix sécuritaire et efficace pour les lombalgies, les antécédents de fractures vertébrales lombaires et les discoïdectomies à niveau unique sans fusion. Celles qui avaient subi des interventions vertebrales ont été celles qui ont le moins profité du soulagement produit par l’ALE. Un plan anesthésique a été adapté sur mesure aux parturientes qui présentaient un spina bifida occulta, une maladie cardiaque, neurologique ou hématologique ainsi que des antécédents de réactions médicamenteuses indésirables à l’anesthésie régionale ou générale. Nous concluons que la CAO rend de grands services aux obstétriciens et anesthésistes pour la conduite anesthésique de parturientes présentant des pathologies associées. La CAO permet l’éducation de la parturiente en regard des options qu’on peut offrir pour le travail et l’accouchement. L’anesthésiste en charge profite de l’évaluation du risque et d’un plan de conduite auquel il a toujours adhéré à deux exceptions près. Finalement, l’obstétricien a profité de conseils utiles sur le conduite anesthésique susceptibles d’affecter la prise de décision obstétricale.
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Rosaeg, O.P., Yarnell, R.W. & Lindsay, M.P. The obstetrical anaesthesia assessment clinic: a review of six years experience. Can J Anaesth 40, 346–356 (1993). https://doi.org/10.1007/BF03009634
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DOI: https://doi.org/10.1007/BF03009634