Introduction: The last twenty years has witnessed important changes in the field of obstetric analgesia and anesthesia. In 2007, we conducted a survey to obtain information regarding the clinical practice of obstetric anesthesia in our country. The main objective was to ascertain whether recent developments in obstetric anesthesia had been adequately implemented into current clinical practice.
Methodology: A confidential questionnaire was sent to 391 identified wiss obstetric anesthetists. The questionnaire included 58 questions on 5 main topics: activity and organization of the obstetric unit, practice of labor analgesia, practice of anesthesia for caesarean section, prevention of aspiration syndrome, and pain treatment after cesarean section.
Results: The response rate was 80% (311/391). 66% of the surveyed anesthetists worked in intermediate size obstetric units (500-1500 deliveries per year). An anesthetist was on site 24/24 hours in only 53% of the obstetric units. Epidural labor analgesia with low dose local anesthetics combined with opioids was used by 87% but only 30% used patient controlled epidural analgesia (PCEA). Spinal anesthesia was the first choice for elective and urgent cesarean section for 95% of the responders. Adequate prevention of aspiration syndrome was prescribed by 78%. After cesarean section, a multimodal analgesic regimen was prescribed by 74%.
Conclusion: When comparing these results with those of the two previous Swiss surveys [1, 2], it clearly appears that Swiss obstetric anesthetists have progressively adapted their practice to current clinical recommendations. But this survey also revealed some insufficiencies:
1. Of the public health system:
a. Insufficient number of obstetric anesthetists on site 24 hours/24.
b. Lack of budget in some hospitals to purchase PCEA pumps.
2. Of individual medical practice:
a. Frequent excessive dosage of hyperbaric bupivacaine during spinal anesthesia for cesarean section.
b. Frequent use of cristalloid preload before spinal anesthesia for cesarean section.
c. Frequent systematic use of opioids when inducing general anesthesia for cesarean section.
d. Fentanyl as the first choice opioid during induction of general anesthesia for severe preeclampsia.
In the future, wider and more systematic information campaigns by the mean of the Swiss Association of Obstetric Anesthesia (SAOA) should be able to correct these points.