Technique of anaesthesia for different grades of caesarean section: a cross-sectional study.

OBJECTIVE The percentage use of regional anaesthesia (RA) and failure rate of RA for different grades of caesarean section (CS) has become a marker of quality for obstetric anaesthesia service. The objective of our prospective observational study is to find out the technique of anaesthesia used in different grades of CS, reasons for choosing general anaesthesia (GA) and failure rate of RA in our hospital setting. METHODS This prospective cross sectional study was carried in the obstetric unit of Aga Khan University Hospital from 1st January 2010 to 31st May 2011. The anaesthetist performing the procedure filled out the data collection proforma .Suggested Indicators were percentages of Grade 1-4 CS done under RA and GA, percent of failed regional, percent of failed regional in different grades of CS. RESULTS A total of 407 patients having undergone Caesarian Section (CS) were reviewed. General Anaesthesia (GA) was used in 201(49%) patients and Regional Anaesthesia (RA) in 206 (51%) patients. There was no significant difference between the use of GA and RA for grade 2-4 CS {grade 2: GA 42 (51%), RA 40 (49%), grade 3: GA 43 (46%), RA 39 (53%), grade 4: GA 81 (44%), RA 101 (55%) with a slight increase margin of difference for grade 1 CS (GA 44 (63%) vs RA 26 (37%)}. Patient preference 42 (45%)was the most common reason for choosing General Anaesthesia.. Fourteen (6.7%) patients required conversion from regional technique to GA. Of these 11 patients had Grade 1-3 CS and three patients had grade 4 or elective CS. CONCLUSION A large percentage (49%) of patients preferred general anaesthesia for CS which is of the International standards. This calls for guidelines regarding the use of Regional Anaesthesia for different grades Caesarian Section. Patient education regarding the use and benefits of Regional Anaesthesia needs to enforced.