Choice of Anaesthetic Technique for Cesarean delivery in Tripoli Medical Centre

There has been a sustained growth in cesarean delivery rate worldwide. From the early reports of maternal deaths from obstetric anaesthesia, it became clear that potential hazards threaten the mother and child whenever an anaesthetic needs to be administered. General anaesthesia for cesarean section is regarded as a special technique comparatively to most commonly used regional technique. There remain very few obstetric situations where general anaesthesia is essential. The aim of our study is to assess the incidence of regional and general anaesthesia in elective and emergency cesarean sections in Tripoli Medical Centre and to compare it with the incidence in other countries. A retrospective study of 1103 patients undergoing cesarean sections during 6 months of 2004 in Tripoli Medical Centre have been performed.817 parturients [74%] have been operated for emergency indications and 286 parturients [26%] as scheduled cases.599 parturients [54.3%] have been operated under general anaesthesia and 504 parturients [45.7%] under spinal anaesthesia.56.8% of parturients operated for emergency indications have been operated under general anaesthesia and 43.2% under spinal anaesthesia.42.7% of elective cesarean sections were performed under general anaesthesia and 52.8% under spinal anaesthesia. The incidence of general anaesthesia for cesarean delivery in Tripoli Medical Centre is 54.3%. This incidence is ten times higher than in some countries in Europe. Misjudgements are common among anaesthesiologists in selection of anaesthetic technique for cesarean section. especially for a scheduled procedure. There is still unjustified negative attitude of many obstetricians and parturients to regional anaesthesia for cesarean delivery

Labor analgesia. pros and cons

Although childbirth is a normaL natural physiologic process, most women experience pain Pain associated with labor and delivery is a stressful experience for both mother and child. There are numerous options available for labor pain control. Analgesia for labor and delivery is now safer than ever. Anesthesia-related maternal mortality has decreased from 4.3 per million live births during 1979 -1981 to less than 1.5 per million live births during 1990-2000 [2. 20]. Epidural analgesia is the most effective method of controlling pain throughout all stages of labor. Each year millions women choose "epidurals" for safe and effective pain relief. The use of epidural analgesia varies widely between countries. In many hospitals today the availability of regional analgesia for labor is considered part of standard obstetric care. There is a 20-30% "epidural rate" for labor in Sweden and Finland, while in Denmark it is around 5-7% [40]. In the USA this varies between-65 and 90% [231. The differences do not reflect actual need for obstetric analgesia. They represent different attitudes to obstetric pain relief in medical circles and in society. Epidural analgesia has not enjoyed widespread acceptance in Libya for several reasons; lack of information available to pregnant women, reluctance by obstetricians, who consider that epidural analgesia may prolong labor, difficulty in organizing an obstetric analgesia service, limited technical knowledge among anesthesiologists and staff shortage issues. This paper is addressed to medical community of Libya. It outlines the following aspects of labor pain control: oOrigin of labor pain. oIndications and contraindications/or epidural analgesia. oTechniques and drugs