Abstract:
ABSTRACT
Introduction
The use of spinal anaesthesia has increased in the last three decades and is the recommended anaesthetic of choice for better fetal and maternal outcomes in caesarean delivery. Failed spinal anaesthesia exposes patients to the unfavourable experience of pain and the potential complications of general anaesthesia that are being avoided in the first instance. Previous studies have shown the safety of spinal anaesthesia over general anaesthesia.
Objective This study aimed to determine the prevalence and factors associated with failed spinal anaesthesia among pregnancy women undergoing caesarean section at MNH.
Methodology
This was a descriptive quantitative cross-sectional study that was done from October 2018 to January 2019 at Muhimbili National. Pregnant women who were scheduled for elective or emergency caesarean section under spinal anaesthesia in the theatre were recruited for this study. For each consenting pregnant woman, a research questionnaire was completed, documenting demographic information, clinical information anaesthetic and surgical information. Statistical Package for Social Scientists (SPSS) version 20 was used for analysis. Continuous variables were presented as mean, standard deviation and categorical variables were presented as a percentage. Association was tested via Chi-square test for categorical variables. A p-value of 0.05 was used for statistical significance.
Results:
The prevalence of failed spinal anaesthesia in pregnant women who underwent a caesarean section at MNH was high (18.2%). Majority of the failed block were partial and all occurred intraoperatively. ).Majority of pregnant women were anaesthetized by a nurse anaesthetist (51%) Failed spinal anaesthesia was associated with the experience of the anaesthesia provider, multiple skin attempts at the puncture site and the level of block achieved (p value<0.001). Obesity, previous spinal anaesthesia, emergency caesarean section, the rank of training, position during induction and, blood CSF did not show a significant association with failed spinal anaesthesia at MNH. Low APGAR Score was also found not to be associated with failed spinal anaesthesia. The complications of spinal anaesthesia were hypotension (30.9%), vomiting (3.6%), high spinal (1.8%) and shivering (9.7%).
Conclusion and recommendations
The prevalence of failed spinal anaesthesia in pregnant women who underwent a caesarean section at MNH was high (18.2%). The majority of failed spinal anaesthesia was partial and occurred intraoperatively. Prevalence of failed spinal anaesthesia was associated with multiple skin attempts at the puncture site, height of the block and experience of the anaesthesia provider. Majority of the pregnant women were anaesthetized by nurse anaesthetists. The complications of spinal anaesthesia were hypotension, vomiting, high spinal and shivering and they were all managed depending on the perception and knowledge of the anaesthesia provider. Presence of senior anaesthesia provider, educating the anaesthesia provider the importance of checking the level of a block after giving spinal, having a protocol on how to proceed after a failed spinal should be considered as preventive strategies to reduce failed spinal anaesthesia prevalence at MNH.
