At all times, the main concern of every practising anaesthetist is the safety of the patient under anaesthesia. In the field of Obstetric Anaesthesia, this concern must of necessity extend to the newly-born baby.
From the early reports of maternal deaths in England and Wales from Obstetric Anaesthesia, it became clear that potential hazards threaten the mother and child whenever an anaesthetic needs to be administered. The ever present dangers of vomiting or regurgitation resulting in pulmonary aspiration of acidic contents (Chapter 26), unexpectedly difficult intubation (Chapter 38), awareness and the possibility of patients being attended to by less experienced personnel (especially after office hours) have all been well documented (1).
The experiences of the worldwide educational programmes run by the World Federation of Societies of Anaesthesiologists (WFSA) over the past forty years show clearly that conditions of work vary markedly in different countries. Differing educational and training standards and the availability, or lack of, supporting staff, essential equipment and drugs contribute to varying standards of professional practice and delivery of health care (Chapter 29). Irrespective of the different factors which contribute to the complex system in which the anaesthetist does his/her work, the bottom line remains the same - the safety of the patient (and the yet-to-be-born baby) will dictate the technique of choice for any obstetric case in any part of the world. Human life is just as valuable anywhere!!
Outcome studies have generally attributed the majority of anaesthetic incidents to human error (2). The main factor minimizing an adverse outcome is a well-trained anaesthetist who is alert and ever present at the patient's side and assisted in his/her task by dependable monitoring equipment. Under these circumstances, the safest anaesthetic technique to be employed by any anaesthetist is arguably the technique he/she is most familiar with, be it a general or a regional.
Notwithstanding the complications that may arise with regional anaesthesia for the obstetric patient (such as toxicity (Chapter 91), hypotension (Chapter 6), cardiac arrhythmias and headache (Chapter 97)), and considering cost benefits and satisfactory outcomes, it appears compelling to forego general anaesthesia (and its associated 'high tech' costs) for the generally economical cost, simplicity of technique and comparative safety of regional anesthesia as the first choice when attending on an obstetric patient.
References:
1. Campling E A, Devlin H B, Lunn J N.
The Report of the National Confidential Enquiry into Perioperative Deaths HMSO UK, 1989.
2. Runciman W Symposium on AIMS Anaesth Intens Care, Vol 21, No 5, October 1993.