Anestéziológia a intenzívna medicína 1/2019

Peripartal anesthesia and analgesia in Slovakia and in the Czech Republic from the OBAAMA - INT Study

Background: In November 2015 an international survey study OBAAMA – INT (OBstetric Anaesthesia and Analgesia Month Attributes – INTernational) was held in Czech and Slovak republics. The study included anaesthesia and analgesia in peripartal period – anaesthesia for Caesarean delivery (CD), obstetric analgesia and anaesthesia within 2 hours after delivery. In total 105 of centres joined the survey, which registered 3607 of patients, 3523 valid. In Slovak republic there were 35 centres, which registered 1148 of valid patients, in Czech republic 70 centres registered 2375 patients. Goal: The purpose of this international survey was to determine anaesthesia and analgesia practice for caesarean delivery, obstetric analgesia, early postpartum anaesthesia in the Czech Republic (CZE) and Slovak Republic (SVK). Methods: In November 2015 we invited all departments of obstetric anaesthesia in the CZE and SVK to participate in a prospective study to monitor consecutive peripartum obstetric anaesthesia and analgesia procedures. Data were recorded online in the CLADE IS database (Masaryk University, CZE). Results: The response rate was 71% of centres, where peripartal anaesthesia and analgesia is provided (70 of 95 in CZE, 35 of 54 in SVK); participating centres represented 87.7% of all births in CZE and 66.4% of all births in SVK during the November 2015. We enrolled 78.6% of all CD in CZE and 64.2% of all CD in SVK, in total 2548 of CD. Anaesthesia during CD: Regional anaesthesia (RA) was used in 67.0% in SVK and in 60.8% in CZE. Preferred drugs used for induction to anaesthesia were in CZE and SVK thiopental and suxamethonium. Analgesia after CD: CZE - systemic opioids 59.3%, nonopioid analgetics 62.2%; in SVK systemic opioids were used only in 17.8%, nonopioids analgetics in 58.9%. Epidural postoperative analgesia was used only in 10.7% patients in CZE and in 3.4% in SVK. Other methods of postoperative analgesia were TAP (Transversus abdominis plane) in 9 patients in SVK, infiltration of wound in 10 patients in CZE and 27 patients in SVK. Analgesia during spontaneus delivery was administered by anaesthesiologist in 12.5 % of deliveries (CZE 12,1 %, SVK 13,4 %), predominantly epidural analgesia (CZE 97,2%, SVK 99,1%). Anaesthesia in early postoperative period: From 3523 cases of anaesthetic care in 181 (5.1%, 147 CZE, 47 SVK) were performed in early postpartum period. In 36 patients (19.9%) anaesthesia was administered after obstetric analgesia, in 3 after CD (1.7%). In 136 patients (92.5%) in CZE and in 32 (94.1%) in SVK general anaesthesia was administered. Complications: The most frequent complication of spinal anaesthesia was more than 2 attempts to achieve neuraxial space (22.8% CZE, 24.9% SVK) in epidural anaesthesia and PEDA also more than 2 attempts (16.1 vs 16% ev. 15.5%). Postpunctional headache was recorded globally in 1.2%. Complications related to general anaesthesia were difficult airways (1.5% CZE, 1.1% SVK), hypertension (9.1 vs 5.3%) and tachycardia (4.8 vs 6.3%). Conclusion: This international study is an important audit, which found that anaesthesiology practice in peripartal period is safe. It found positive but also negative parts of this practice in both countries and will be a valuable asset for next education of anaesthesiologists and in improvement of access of parturient mainly to labour analgesia, which is actually weak in both countries. The audit will serve for comparison in the future.

Keywords: anaesthesia, analgesia, peripartal period, labour