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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2014 March;80(3):347-54
Current practice in obstetric anesthesia: a 2012 European survey
Staikou C. 1, Paraskeva A. 1, Karmaniolou I. 2, Mani A. 3, Chondrogiannis K. 1 ✉
1 Department of Anesthesia, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece;
2 Department of Anesthesia, Royal National Orthopedic Hospital, Brockley Hill, Stanmore, Middlesex, UK;
3 Department of Anesthesia, Klinikum Starnberg, Starnberg, Germany
Background: New scientific findings are gradually implemented into daily clinical routine. The present questionnaire survey investigated the current practice in obstetric anesthesia in Europe.
Methods: A 19-point questionnaire on obstetric anesthesia practices, regarding the techniques, drugs, fluids, vasopressors and safety measures, was uploaded on the site of the European Society of Anaesthesiology (21/12/2011 to 21/12/2012).
Results: Three hundred and forty-one (341) completed questionnaires were analyzed. Single-shot subarachnoid anesthesia is preferred by 225 (66%) respondents in uncomplicated Cesarean deliveries and by 190 (55.7%) in preeclampsia. Most anaesthesiologists (N.=133, 39%) perform neuraxial techniques if platelet count exceeds 80000/mm3. In anticipated hemorrhage, general anesthesia is administered by 165 (48.4%) respondents. Anesthesia is induced with thiopental/succinylcholine by 193 (56.6%) survey participants, usually under cricoid pressure (N.=201, 58.8%). For prevention of the hypotension associated with regional anesthesia, coloading with 1L of crystalloid represents the most popular measure undertaken by 80 (40.2%) respondents, while vasopressors are not favored (N.=260, 76.2%). For hypotension treatment, ephedrine is preferred over phenylephrine by 124 (36.4%) versus 79 (23.2%) anesthesiologists. Supplemental oxygen is routinely administered to parturients receiving regional anesthesia by 176 (51.6%) respondents. The standard dose of oxytocin is 5IU, according to most answers (N.=160, 46.9%).
Conclusion: Subarachnoid anesthesia is mostly favored among European anesthesiologists, while general anesthesia is reserved only for cases with anticipated hemorrhage. Fluid coloading and phenylephrine have gained popularity, in line with current knowledge. Conversely, cricoid pressure, standard supplemental oxygen and high oxytocin doses ‑ though strongly questioned ‑ are still advocated by most anaesthesiologists.