Abstract
To ascertain the anaesthetic complications requiring postanaesthetic respiratory support in a large obstetrical hospital, the hospital records of obstetrical patients admitted to an adjacent general intensive care unit (ICU) were studied. Obstetrical patients who required mechanical ventilation following anaesthetic complications were identified and their hospital records reviewed. In a ten-year period there were 61,435 women delivered at the Mater Mothers Hospital (MMH) in Brisbane, Queensland, Australia. Of these 24,161 had an anaesthetic associated with delivery including 7,452 general anaesthetics (GAs) and 16,709 regional anaesthetics (RAs). There were also 3,708 GAs and 17 RAs for procedures other than delivery. During this period there were 126 obstetrical admissions to the ICU. Sixteen were due to anaesthetic complications, twelve followed GA and four followed RA. Complications included anaphylaxis, high block and failure of tracheal intubation. The incidence of a major complication of a GA causing admission to the ICU was I in 932 and for RA was I in 4177 when these were given for delivery (P < 0.01). If a complication requiring ICU admission and mechanical ventilation is used as the criterion of safety it appears that RA is safer than a GA for delivery.
Résumé
Afin de délimiter les complications anesthésiques requérant un support respiratoire postanesthésique, les dossiers des patientes obstétricales admises à l’unité des soins intensifs généraux (ICU) furent étudiés dans un grand hôpital obstétrical. Les patientes admises dans le departement d’obstétrique qui ont nécessité la ventilation mécanique après des complications anesthésiques furent identifiées et leurs dossiers furent revus. Pour une période de dix ans 61 435 femmes ont accouché à la “Mater Mothers Hospital (MMH)” de Brisbane, Queensland, Australie. Parmi celles-ci, 24 161 patientes ont reçu des anésthesiques pour l’accouchement incluant 7452 anesthésies générates (GAs) et 16 709 anesthésies régionales (RAs). On a compté aussi 3 708 GAs et 17 RAs pour des procédures autres que l’accouchement. Pendant cette période, on a compté 126 admissions obstétricales à l’ICU. Seize étaient dues à des complications anesthésiques, 12 postanesthésies générales et quatre postanesthesies régionales. Les complications incluent l’anaphylaxie, un risque élevé et l’impossibilité d’intubation trachéale. L’incidence de complications majeures de l’anesthésie générate provoquant l’admission an ICU était de 1 sur 932 et pour l’anesthésie générate de 1 sur 4 177 quand ces procédures furent administrées lors de l’accouchement (P < 0.01). Si l’admission à l’ICU et la ventilation mécanique est utilisée comme critère de sécurité, il apparaît que l’anesthésie régionale est plus sécuritaire que l’anesthésie générate pour l’accouchement.
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Stephens, I.D. ICU admissions from an obstetrical hospital. Can J Anaesth 38, 677–681 (1991). https://doi.org/10.1007/BF03008207
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DOI: https://doi.org/10.1007/BF03008207