Anesthesia for Cesarean Delivery in the Czech Republic: A 2011 National Survey

• Published in: Anesthesia and analgesia Vol. 120; no. 6; pp. 1303 - 1308
• Main Authors: Stourac, Petr, Blaha, Jan, Klozova, Radka, Noskova, Pavlina, Seidlova, Dagmar, Brozova, Lucie, Jarkovsky, Jiri
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.06.2015
• Subjects: Analgesia, Epidural - trends; Analgesia, Obstetrical - trends; Anesthesia, Conduction - adverse effects; Anesthesia, Conduction - trends; Anesthesia, General - trends; Anesthesia, Obstetrical - adverse effects; Anesthesia, Obstetrical - trends; Anesthesia, Spinal - trends; Cesarean Section - adverse effects; Cesarean Section - trends; Czech Republic; Elective Surgical Procedures; Emergencies; Female; Health Care Surveys; Hospitals, High-Volume - trends; Hospitals, Low-Volume - trends; Hospitals, University - trends; Humans; Pain, Postoperative - prevention & control; Practice Patterns, Physicians' - trends; Pregnancy; Time Factors; Treatment Outcome; Czech Republic
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000000572

BACKGROUND:The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic. METHODS:In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). RESULTS:The response rate was 51% (49 of 97 departments); participating centers represented 60% of all births in the country during the study period. There were 1943 cases of peripartum anesthesia care, of which 1166 cases (60%) were anesthesia for cesarean delivery. Estimates were weighted based on population distribution of cesarean delivery among types of participating centers. Neuraxial anesthesia was used in 55.6% (95% confidence interval [CI], 52.8%–58.5%); the distribution of anesthesia techniques differed among type of participating center. The rate of neuraxial anesthesia in university hospitals was 55.6% (95% CI, 51.5%–59.6%), 32.4% (95% CI, 26.4%–39.0%) in regional hospitals, and 60.7% (95% CI, 55.2%–66.0%) in local hospitals. The reasons for cesarean delivery under general anesthesia were emergency procedure (67%), refusal of neuraxial blockade by parturient (30%), failure of neuraxial anesthesia (6%), and preoperative administration of low-molecular-weight heparin (3%). Postcesarean analgesia was primarily provided by systemic opioid (66%) and nonopioid analgesics (61%), solely or in combination. Epidural postoperative analgesia was used in 14% of cases. Compared with national neuraxial anesthesia rate data published in the 1990s (6.7% in 1993), there has been an upward trend in the use of neuraxial anesthesia for cesarean delivery during the 21st century (40.5% in 2000) in the Czech Republic. CONCLUSIONS:The rate of neuraxial anesthesia use for cesarean delivery has increased in the Czech Republic in the last 2 decades. However, the current rate of general anesthesia is high compared with other Western countries.