| Summary: | 碩士 === 臺北醫學大學 === 醫務管理學研究所 === 95 === Background and Aim: Epidural anesthesia is one of the regional anesthesias that anesthesiologists usually perform for patients. Accidental dural puncture is the most frequently occurring complications while performing epidural anesthesia. The aim of this study is to explore the factors influencing the accidental dural puncture rate by anesthetists.
Method: We retrospectively analyzed 15,932 cases of epidural anesthesia collected from a teaching medical center since October 1990 to May 2006. The influence of patient factors (included: age, sex, type of operation, ASA classification, emergency, invasive hemodynamic monitors) and work factors (included: anesthesia time, work shifts, cumulative work hours, anesthetists’ experience, concurrency) to the rate of accidental dural puncture was analyzed.
Results: Old age, non-obstetric operation, late night shift, 1st year and 2nd year training resident were associated with higher rates of accidental dural puncture. By logistic regression, the odds ratios in terms of accidental dural puncture rates for orthopedic operations and non-orthopedic non-obstetric operations are 3.53 and 2.81 in comparison with obstetric operations. Late night shift is 4.42 times more than day shift. 1st year and 2nd year training resident are 3.20 and 3.03 times more than attending anesthesiologist.
Conclusion: In order to reduce the accidental dural puncture, we recommend the following policies: First, limiting the inexperienced doctors not to perform epidural anesthesia for high risk patients during late night shifts; Second, reduce the patient amount of late night shifts; Third, increase doctors’ epidural anesthesia experience.
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