Anaesthetic techniques used for Caesarean section in rural Zimbabwe
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Background: In 2013 the Zimbabwe Anaesthetic Association highlighted the need for more knowledge about the anaesthetic practice for Caesarean sections (CS) in the hospitals at district and provincial level in the country. Aims of the study: The primary aim of the study is to assess the type of anaesthesia given for CS in the peripheral hospitals of Zimbabwe. Secondary aims are to gain knowledge about the availability of essential anaesthetic drugs and equipment, and the level of training of the anaesthetic providers. Methods: A list of hospitals performing CS in Zimbabwe was obtained, and by stratified random sampling a number of them was included in the study. One anaesthetic provider from each of these chosen hospitals was interviewed face-to-face using a pre-designed questionnaire. Results: Out of 81 peripheral hospitals performing CS, 42 were included in the study. The majority of CS (81 %) were done under spinal anaesthesia. The remaining (19 %) were done under general anaesthesia with ketamine only or inhalational gas. There were no significant differences in the proportion of spinal anaesthesia used in the different types of hospitals. Intravenous cannulas (IV cannulas) were used instead of dedicated spinal needles in 48 % of the hospitals. The use of checklists/guidelines and postoperative recovery area was poor. The availability of recommended vasopressors was also poor with adrenaline used as first line vasopressor. Of the anaesthetic providers interviewed 59 % were qualified to provide anaesthesia. Conclusion: A higher proportion of CS than expected is performed under spinal anaesthesia in provincial, district and mission hospitals. However, a number of factors compromising the safety of spinal anaesthesia were identified: shortage of essential vasoactive drugs; use of IV cannulas to establish subarachnoid block; and provision of anaesthesia by a high proportion of unqualified staff.