| Summary: | A research report submitted to the Faculty of Health Sciences, University
of the Witwatersrand, in partial fulfilment of the requirements for the
degree
of
Master of Medicine in the branch of Anaesthesiology
Johannesburg, 2014 === Currently spinal anaesthesia is widely considered as the safest technique for
caesarean section because the increased risk of failed intubation and aspiration
associated with pregnant patients is avoided. In South Africa the latest confidential
enquiry into maternal mortality for the triennium 2008 – 2010 showed that the
maternal mortality rate due to anaesthesia is approximately 5 per 100 000 live births,
and the majority (79%) occurred under spinal anaesthesia. This represents a high
rate of maternal mortality due to anaesthesia, and particularly spinal anaesthesia,
when compared to developed countries. Good anaesthetic records are vital in
understanding why the maternal mortality rate due to anaesthesia is so high, and the
parameters that are recorded following spinal anaesthesia has not been investigated
in South Africa.
The primary objectives of this study were to describe the demographics, essential
procedural parameters, additional procedural parameters and the clinical parameters
recorded following spinal anaesthesia for caesarean section.
The secondary objectives of this study were to compare whether surgery being
performed during the week or over the weekend, surgery being performed during the
day or during the night, surgery being routine or an emergency or the category of
anaesthetist influenced the parameters recorded.
The research design used in this study was that of a retrospective, contextual,
descriptive study. The study population was the anaesthetic records completed
following spinal anaesthesia for caesarean section in the maternity theatres of Chris
Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic
Hospital and Rahima Moosa Mother and Child Hospital. Consecutive convenience
sampling was used to select 300 anaesthetic records to be enrolled into the study.
Anaesthetic records at each hospital were reviewed from 30 June 2013 backwards
until the required sample size for each hospital was reached. Records were enrolled
into the study proportionally to the average number of caesarean sections performed
at each hospital per month.
The majority of records were completed during the week and during the night, most
of these anaesthetic records were for emergency surgeries and most were
completed by registrars.
The study revealed that demographic data and identifying parameters were recorded
thoroughly. Eight of the twelve essential procedural parameters were recorded
adequately. From the twelve additional procedural parameters identified from the
records only two were recorded adequately and from the five clinical parameters
reviewed four were recorded acceptably.
Records were found to be more comprehensive when completed during the week,
when completed during the night, when completed for emergency surgery and when
completed by a registrar.
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