General Anaesthesia is Prefered to Spinal Anaesthesia for Emergency Caesarean
Section
KO Enohumah, JO Hinz, TA Crozier.
Department of Anaesthesiology, Emergency and Intensive Care Medicine,
Georg-August-University,
Goettingen, Germany.

Introduction
WHO estimates that 529,000 women die each year from complications of pregnancy or child-birth. This amounts to more than one death per minute. Fourteen percent of live births but less than 1% of maternal deaths take place in developed countries while 99% of all maternal deaths occur in developing countries1. The number of deaths due to anaesthesia has decreased in developed countries largely because of improved
methods, monitoring and the emergence of consultant–led obstetric anaesthesia subspecialty. With the decline in the number of anaesthesia related maternal deaths in developed countries as reported in the CEMD and by various centres maternal mortality data offer fewer opportunities for directing further improvement in obstetric care2,,3. Useful alternative indicators might be severe morbidity, critical-incident reporting of near misses, or severe maternal morbidity-mortality ratio. The purposes of this study are aimed at determining the effect of choice of anaesthetic technique on maternal morbidity; analyze the causes of maternal morbidity and their relationship to anaesthetic
management.
Methods
The anaesthetic charts of all obstetric patients who had a caesarean section in the University hospital of Goettingen Germany during the period June 1, 1999 to May 31, 2004 were reviewed. The charts were manually retrieved from the archives of the department of Anaesthesiology, Emergency and Intensive care, University Hospital Gottingen, Germany. Data were also assessed from the surgical records for caesarean section from the Department of Obstetrics and Gynaecology in the same institution. Data obtained were
compared with those from the total statistics for deliveries from Lower Saxomy and German Federal statistics office.
Results
During the period under review, a total of 4,453 births occurred in the hospital. Caesarean section accounted for 1,418 deliveries giving a caesarean section rate of 31.8%. Regional anaesthesia was performed in 618 (43.6 %) cases and 800 (56.4 %) patients had general anaesthesia. General anaesthesia was the commonest technique employed for caesarean section. Anaesthesia did not result in any mortality.

Conclusion
The decision to use a particular anaesthetic technique should be individualised based on the preferences of the patient and the anaesthesiologist as well as anaesthetic, obstetric and /or fetal risk factors. Availability of resources as well as trained personnel skilled in the management of potential complications such as airway management should be ensured.
References

1. Maternal Mortality in 2000: Estimates developed by WHO, UNICEF, UNFPA. Geneva, World Health Organization, 2004.
2. Robinson APC, Gordon Lyons. Morbidity and mortality from obstetric anaesthesia in the 1990s. Curr Opin Anaesthesiol 1999; 12:277-281.
3. 3. Thomas TA, Cooper GM. Maternal deaths from anaesthesia. An extract from Why Mothers Die 1997-1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Anaesth 2002; 89:499-508.

Acknowledgement
We would like to thank Prof. Emons, Director, department of obstetrics and gynaecology and Dr. Jan Bahr for assisting us with data.

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