Skip to main content
SpringerLink
Log in

Anästhesiologisches Management der Sectio caesarea

Deutschlandweite Umfrage

Anesthesiological management of Caesarean sections

Nationwide survey in Germany

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Deutschlandweit bringen anteilig immer mehr Schwangere ihr Baby per Sectio caesarea (SC) zur Welt. Einige Aspekte des anästhesiologischen Managements der SC sind durch neuere Erkenntnisse in den Fokus der Fachliteratur geraten [z. B. Hydrierung der Patientinnen bei Spinalanästhesie (SPA) zur SC oder Zeitpunkt der Antibiotikagabe bei SC]; andere (z. B. Ausbildungsstand von Assistenzärzten bei eigenverantwortlichem Arbeiten im Kreißsaal oder Verwendung von Lachgas zur Vollnarkose bei SC) sind bisher kaum systematisch untersucht. Ziel der Umfrage war es, einen repräsentativen Überblick über das anästhesiologische Management bei SC in Deutschland zu erhalten.

Material und Methoden

Ein Fragebogen mit 52 Fragen wurde an 709 Chefärzte anästhesiologischer Kliniken verschickt und die Antworten ausgewertet.

Ergebnisse

Die Rücklaufquote betrug 50,8%. Die dadurch repräsentativ erfasste Zahl der Geburten betrug etwa 330.000, die der Kaiserschnittentbindungen etwa 90.000. Das Anästhesieverfahren der Wahl ist in Deutschland überwiegend die SPA (90,8%) mit hyperbarem Bupivacain, in ca. einem Drittel der Kliniken ohne Opioid. Etwa 12% verwenden zur SPA traumatische Quincke-Nadeln. Lachgas setzen 19,2% der Kliniken bei einer Allgemeinanästhesie zur SC ein. In 11% der Krankenhäuser wird präpartal ein Antibiotikum verabreicht. In 43,1% befindet sich kein Pädiater rufbereit zur Versorgung kranker Neugeborener. Fast ein Drittel (32,1%) der Kliniken lässt Assistenzärzte mit unter 2-jähriger Berufserfahrung selbstständig im Kreißsaal arbeiten.

Schlussfolgerung

Als Anästhesieverfahren der Wahl für die SC hat sich die SPA eindeutig durchgesetzt. Lachgas spielt keine bedeutende Rolle in der Praxis der SC. Verbesserungsbedarf bei der anästhesiologischen Versorgung der SC besteht insbesondere bei der Auswahl der Spinalkanülen und hinsichtlich des Zeitpunkts der Antibiotikaprophylaxe.

Abstract

Background

The rate of Caesarean sections in Germany continues to rise. The change in anesthetic technique of choice from general to spinal anesthesia began later than in other countries and at the last survey in 2002 was not widely established. The literature on the anesthetic management of Caesarean sections contains many controversies, for example fluid preload before performing spinal anesthesia and the vasopressor of choice. Other issues have received relatively little attention, such as the level of experience of anesthesiologists working autonomously on the labour ward or the timing of antibiotic prophylaxis. The aim of the current survey was to provide an updated overview of anesthetic management of Caesarean sections in Germany.

Material and Methods

A questionnaire was sent out to 709 departments of anesthesiology serving obstetric units in Germany. The questionnaire concerned various aspects of anesthetic management of Caesarean sections.

Results

A total of 360 questionnaires (50.8%) were returned of which 346 were complete and could be analyzed, accounting for 330,000 births and 90,000 Caesarean sections per year. The predominant anesthetic method used for Caesarean sections was spinal anesthesia (90.8%) using hyperbaric bupivacaine and in approximately one third of the hospitals surveyed without administering intrathecal opioids. Approximately 12% of the departments surveyed used traumatic Quincke needles. In 86.2% the vasopressor of choice was caffedrine/theodrenaline. Nitrous oxide was used in only 19.2% of departments surveyed when general anesthesia is performed. An antibiotic drug was administered in only 11% of hospitals before cord clamping. In 43.1% no neonatologist was available to treat unexpected critically ill newborns. In 32.1% of departments surveyed residents with less than 2 years experience worked autonomously on the labour ward.

Conclusions

Currently the predominant anesthetic technique of choice in Germany is spinal anaesthesia and at a much higher rate than in 2002. In addition 12% of departments use traumatic Quincke needles which are associated with a higher incidence of postpuncture headache. Nitrous oxide is no longer frequently used in Germany. Finally, the administration of an antibiotic before cord clamping has been shown to lead to lower rates of endometritis and postoperative wound infection without detrimental effects on the newborn. This is practiced in only a small minority of departments across Germany.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Alfirevic Z, Gyte GM, Dou L (2010) Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 10:CD008726

    PubMed  Google Scholar 

  2. Algert CS, Bowen JR, Giles WB et al (2009) Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study. BMC Med 7:20, doi:10.1186/1741-7015-7-20

    Article  PubMed  Google Scholar 

  3. Allen TK, Muir HA, George RB, Habib AS (2009) A survey of the management of spinal-induced hypotension for scheduled cesarean delivery. Int J Obstet Anesth 18:356–361

    Article  PubMed  CAS  Google Scholar 

  4. Banerjee A, Stocche RM, Angle P, Halpern SH (2010) Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta- analysis. Can J Anaesth 57:24–31

    Article  PubMed  Google Scholar 

  5. Bogra J, Arora N, Srivastava P (2005) Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol 5:5

    Article  PubMed  Google Scholar 

  6. Boutonnet M, Faitot V, Katz A et al (2010) Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted? Br J Anaesth 104:67–70

    Article  PubMed  CAS  Google Scholar 

  7. Clemens KE, Quednau I, Heller AR, Klaschik E (2010) Impact of cafedrine/theodrenaline (Akrinor®) on therapy of maternal hypotension during spinal anesthesia for Cesarean delivery: a retrospective study. Minerva Ginecol 62:515–524

    PubMed  CAS  Google Scholar 

  8. Dinsmoor MJ, Gilbert S, Landon MB et al (2009) Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery. Obstet Gynecol 114:752–756

    Article  PubMed  Google Scholar 

  9. Gunusen I, Karaman S, Ertugrul V, Firat V (2010) Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care 38:647–653

    PubMed  CAS  Google Scholar 

  10. Gogarten W, Van Aken H, Kessler P et al (2009) Durchführung von Analgesie- und Anästhesieverfahren in der Geburtshilfe. Anaesthesiol Intensivmed 50:S502–S507

    Google Scholar 

  11. Kainer F, Hasbargen U (2008) Emergencies associated with pregnancy and delivery: peripartum hemorrhage. Dtsch Arztebl Int 105:629–638

    PubMed  Google Scholar 

  12. Karaman S, Kocabas S, Uyar M et al (2006) The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol 23:285–291

    Article  PubMed  CAS  Google Scholar 

  13. Khaw KS, Ngan Kee WD, Wong M et al (2002) Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg 94:680–685

    Article  PubMed  CAS  Google Scholar 

  14. Leslie K, Myles PS, Chan MT et al (2011) Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial. Anesth Analg 112:387–393

    Article  PubMed  Google Scholar 

  15. Malinovsky JM, Renaud G, Le Corre P et al (1999) Intrathecal bupivacaine in humans: influence of volume and baricity of solutions. Anesthesiology 91:1260–1266

    Article  PubMed  CAS  Google Scholar 

  16. Marcus HE, Fabian A, Lier H et al (2010) Survey on the use of oxytocin for caesarean section. Minerva Anestesiol 76:890–895

    PubMed  CAS  Google Scholar 

  17. Marcus HE, Fabian A, Dagtekin O et al (2011) Pain, postdural puncture headache, nausea, and pruritus after cesarean delivery – a survey of prophylaxis and treatment. Minerva Anestesiol

  18. Myles PS, Leslie K, Chan MT et al; ENIGMA Trial Group (2007) Avoidance of nitrous oxide for patients undergoing major surgery: a randomized trial. Anesthesiology 107:221–231

    Article  PubMed  CAS  Google Scholar 

  19. Prakash S, Pramanik V, Chellani H et al (2010) Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomised study. Int J Obstet Anesth 19:24–30

    Article  PubMed  CAS  Google Scholar 

  20. Santanen U, Rautoma P, Luurila H et al (2004) Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache. Acta Anaesthesiol Scand 48:474–479

    Article  PubMed  CAS  Google Scholar 

  21. Smail FM, Gyte GM (2010) Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev (1):CD007482

    Google Scholar 

  22. Smiley RM (2009) Burden of proof. Anesthesiology 111(3):470–472

    Article  PubMed  Google Scholar 

  23. Owens SM, Brozanski BS, Meyn LA, Wiesenfeld HC (2009) Antimicrobial prophylaxis for cesarean delivery before skin incision. Obstet Gynecol 114:573–579

    Article  PubMed  Google Scholar 

  24. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S (2000) Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 91:916–920

    Article  PubMed  CAS  Google Scholar 

  25. Vercauteren MP, Coppejans HC, Hoffmann VL et al (1998) Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarean section. Anesth Analg 86:989–993

    PubMed  CAS  Google Scholar 

  26. Walsh CA (2010) Evidence-based cesarean technique. Curr Opin Obstet Gynecol 22:110–115

    Article  PubMed  Google Scholar 

  27. Wulf H, Stamer U (1998) Current practices in anesthesia for cesarean section in German university clinics. Results of a survey in the year 1996. Anaesthesist 47:59–63

    Article  PubMed  CAS  Google Scholar 

  28. Wulf H, Stamer U, Wiese R et al (2005) Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand 49(2):170–176

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland

    H.E. Marcus, A. Behrend, R. Schier, O. Dagtekin, P. Teschendorf, B.W. Böttiger & F. Spöhr

Authors
  1. H.E. Marcus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Behrend
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Schier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Dagtekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Teschendorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B.W. Böttiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Spöhr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.E. Marcus.

Anhang

Anhang

Originalfragebogen (Abb. 1).

Abb. 1
figure 1a

Fragebogen zum anästhesiologischen Management der Sectio caesarea. ACTH Adrenokortikotropin, CSE „combined spinal and epidural anaesthesia“, ITN Intubationsnarkose, KH Krankenhaus, LA Lokalanästhetikum, NSAID „non-steroidal anti-inflammatory drugs“, PDA Periduralanästhesie, RR Blutdruck, gemessen nach Riva-Rocci, SOP „standard operating procedure“, SPA Spinalanästhesie

Full size image
Abb. 1
figure 1b

Fortsetzung

Full size image
Abb. 1
figure 1c

Fortsetzung

Full size image
Abb. 1
figure 1d

Fortsetzung

Full size image
Abb. 1
figure 1e

Fortsetzung

Full size image
Abb. 1
figure 1f

Fortsetzung

Full size image
Abb. 1
figure 1g

Fortsetzung

Full size image
Abb. 1
figure 1h

Fortsetzung

Full size image
Abb. 1
figure 1i

Fortsetzung

Full size image
Abb. 1
figure 1j

Fortsetzung

Full size image

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marcus, H., Behrend, A., Schier, R. et al. Anästhesiologisches Management der Sectio caesarea. Anaesthesist 60, 916–928 (2011). https://doi.org/10.1007/s00101-011-1931-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-011-1931-y

Schlüsselwörter

Keywords

Search

Navigation