PDF(Pubmed)
Abstract：
BACKGROUND: Failed spinal anaesthesia causes prolonging of operation time, insufficient analgesia for surgery and needs repeating spinal anaesthesia which in turn causes local anaesthesia toxicity, high spinal and total spinal, and conversion to general anaesthesia. However, the problem remains unexplored in Amhara regional state comprehensive specialized hospitals.
OBJECTIVE: To determine incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery in selected Amhara National Regional State comprehensive specialized hospitals, Northwest Ethiopia, 2023.
METHODS: Multi-center prospective observational study was conducted. Data was collected using questionnaire and checklist. All consecutive scheduled emergency and elective patients were included in the study. Data was transformed from Epi data to SPSS and logistic regression analysis was done. Both crude and adjusted odds ratio were used to assess the strength of association. Variables with a p-value of less than 0.05 were considered as statistically significant.
RESULTS: A total of 532 patients were included in this study with a response rate of 98%. Incidence of failed spinal anaesthesia was 22.4% (CI = 19-25.9). Emergency surgery (AOR = 7.01, CI = 4.5-12.7), dose of bupivacaine of ≤ 10 mg (AOR = 3.02, CI = 1.3-10.2), work experience of anaesthetist < 2 years (AOR = 3.1, CI = 1.7-5.72), bloody CSF (AOR = 8.5, CI = 2.53-18.5), hyperbaric local anaesthetic drug (AOR = 3.3, 95% CI = 3.2-8.2) and local anaesthetist without adjuvants (AOR = 5.25, CI = 2.62-14.2) were associated failed spinal anaesthesia.
CONCLUSIONS: The incidence of failed spinal anaesthesia was high in Amhara Region comprehensive specialized hospitals. We suggest that anaesthesia providers should minimize failure by using adjuvants and appropriate dose of local anaesthetic. Additionally, simulation training should be given for anaesthesia trainees to improve their skills and to produce competent professionals.
OBJECTIVE: To determine incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery in selected Amhara National Regional State comprehensive specialized hospitals, Northwest Ethiopia, 2023.
METHODS: Multi-center prospective observational study was conducted. Data was collected using questionnaire and checklist. All consecutive scheduled emergency and elective patients were included in the study. Data was transformed from Epi data to SPSS and logistic regression analysis was done. Both crude and adjusted odds ratio were used to assess the strength of association. Variables with a p-value of less than 0.05 were considered as statistically significant.
RESULTS: A total of 532 patients were included in this study with a response rate of 98%. Incidence of failed spinal anaesthesia was 22.4% (CI = 19-25.9). Emergency surgery (AOR = 7.01, CI = 4.5-12.7), dose of bupivacaine of ≤ 10 mg (AOR = 3.02, CI = 1.3-10.2), work experience of anaesthetist < 2 years (AOR = 3.1, CI = 1.7-5.72), bloody CSF (AOR = 8.5, CI = 2.53-18.5), hyperbaric local anaesthetic drug (AOR = 3.3, 95% CI = 3.2-8.2) and local anaesthetist without adjuvants (AOR = 5.25, CI = 2.62-14.2) were associated failed spinal anaesthesia.
CONCLUSIONS: The incidence of failed spinal anaesthesia was high in Amhara Region comprehensive specialized hospitals. We suggest that anaesthesia providers should minimize failure by using adjuvants and appropriate dose of local anaesthetic. Additionally, simulation training should be given for anaesthesia trainees to improve their skills and to produce competent professionals.
摘要：
背景：脊髓麻醉失败导致手术时间延长，手术镇痛不足，需要重复脊髓麻醉，这反过来又导致局部麻醉毒性，高脊柱和全脊柱，转换为全身麻醉。然而,在阿姆哈拉地区州立综合专科医院，这个问题仍未得到探索。
目的：确定在选定的阿姆哈拉国家区域州立综合专科医院接受手术的患者中，脊柱麻醉失败的发生率和相关因素，埃塞俄比亚西北部,2023年。
方法：进行多中心前瞻性观察研究。使用问卷和检查表收集数据。所有连续计划的急诊和择期患者均纳入研究。将数据从Epi数据转换为SPSS并进行逻辑回归分析。粗比值比和调整后比值比都用于评估关联强度。具有小于0.05的p值的变量被认为是统计学上显著的。
结果：本研究共纳入532例患者，有效率为98%。脊髓麻醉失败的发生率为22.4％（CI=19-25.9）。急诊手术（AOR=7.01，CI=4.5-12.7），布比卡因的剂量≤10mg（AOR=3.02，CI=1.3-10.2），麻醉师工作经验<2年（AOR=3.1，CI=1.7-5.72），血脑脊液（AOR=8.5，CI=2.53-18.5），高压局部麻醉药物(AOR=3.3,95%CI=3.2-8.2)和无佐剂的局部麻醉师(AOR=5.25,CI=2.62-14.2)与脊髓麻醉失败相关.
结论：阿姆哈拉地区综合性专科医院的脊髓麻醉失败发生率较高。我们建议麻醉提供者应通过使用佐剂和适当剂量的局部麻醉剂来最大程度地减少失败。此外,应对麻醉学员进行模拟训练，以提高他们的技能并培养合格的专业人员。
目的：确定在选定的阿姆哈拉国家区域州立综合专科医院接受手术的患者中，脊柱麻醉失败的发生率和相关因素，埃塞俄比亚西北部,2023年。
方法：进行多中心前瞻性观察研究。使用问卷和检查表收集数据。所有连续计划的急诊和择期患者均纳入研究。将数据从Epi数据转换为SPSS并进行逻辑回归分析。粗比值比和调整后比值比都用于评估关联强度。具有小于0.05的p值的变量被认为是统计学上显著的。
结果：本研究共纳入532例患者，有效率为98%。脊髓麻醉失败的发生率为22.4％（CI=19-25.9）。急诊手术（AOR=7.01，CI=4.5-12.7），布比卡因的剂量≤10mg（AOR=3.02，CI=1.3-10.2），麻醉师工作经验<2年（AOR=3.1，CI=1.7-5.72），血脑脊液（AOR=8.5，CI=2.53-18.5），高压局部麻醉药物(AOR=3.3,95%CI=3.2-8.2)和无佐剂的局部麻醉师(AOR=5.25,CI=2.62-14.2)与脊髓麻醉失败相关.
结论：阿姆哈拉地区综合性专科医院的脊髓麻醉失败发生率较高。我们建议麻醉提供者应通过使用佐剂和适当剂量的局部麻醉剂来最大程度地减少失败。此外,应对麻醉学员进行模拟训练，以提高他们的技能并培养合格的专业人员。
