[A survey of anaesthesia for caesarean section in Poland]

Obstetric anaesthesia and analgesia have come to be regarded as a subspecialty.Various countries and societies have published evidence-based guidelines. In this paper are presented the results of a survey of anaesthesia for Caesarean section (CS), conducted in Poland in 2009.

432 questionnaires were sent. The questions asked related to: characteristics of the hospital, premedication, preoperative laboratory screening, methods of anaesthesia, local analgesic agents (LA), postoperative enteral feeding, positioning, and analgesia.

The questionnaire return rate was 24%. Only 10 hospitals (out of 98) employed anaesthesiologists exclusively for obstetric anaesthesia and analgesia. Alkalinisation of gastric contents, gastric emptying drugs and H blockers were used in 38% of hospitals in elective CS, and in 32% of hospitals in emergency CS. Preoperative laboratory screening was conducted in 93% of hospitals before elective CS, and 77% before emergency CS (usually haematocrit, haemoglobin concentration, red blood count and platelets). In 50% of hospitals, the lowest acceptable concentration of platelets before central blocks was 100,000; while in 30% of hospitals, a level of 50,000 was considered acceptable. Spinal anaesthesia was used in more than 90% of elective CS cases in 75% of hospitals, in emergency CS--in 50% of patients only and in the presence of a foetal stress in 65% of hospitals general anaesthesia was preferred. Bupivacaine remains the most commonly used LA (97%). Lidocaine is still used in 3% of hospitals, and adjuvants are used in 42% of hospitals. The flat supine position was recommended in 75% of hospitals; and 13% of parturients were requested to stay in this position for 24 hours. In 74% of hospitals, enteral feeding was delayed, and in 27% was delayed for 24 hours after CS (27%). Postoperative analgesia was based on parenteral analgesics (usually paracetamol and ketoprofen). Pethidine was used in 35% of hospitals.

There is an urgent need for national guidelines on obstetric anaesthesia and analgesia in Poland.