The routine use of lumbar epidural anaesthesia in obstetrics: A clinical review of 9,532 cases

Abstract

A report is given of an attempt by the anaesthetic staff of the New Mount Sinai Hospital, Toronto, to evaluate lumbar epidural anaesthesia as a routine anaesthetic in obstetrics. This was done primarily in order to eliminate the threat of maternal mortality through the aspiration of stomach contents. To anaesthetize all obstetrical patients in this manner it was necessary to obtain the full co-operation of the entire obstetrical, anaesthetic, and nursing staffs. It was also necessary to modify the technique of lumbar epidural anaesthesia so that the procedure takes only about three minutes. Surgical scrub of the hands and the donning of a sterile gown have been omitted from the technique, with no evidence of infection in the reported 9,532 obstetrical cases and 5,091 surgical cases. The classically dreaded complication of total spinal anaesthesia occurred four times or 0.42 per cent, and that of convulsions occurred six times or 0.63 per cent. All cases responded to therapy without apparent harm to mother or infant. Lesser complications occurred infrequently and have been discussed in the paper. There were no anaesthetic deaths in this series. Labour is apparently not slowed by epidural anaesthesia and dilatation of the cervix seems to be hastened. After three years of this experiment, we now use lumbar epidural anaesthesia for over 90 per cent of our vaginal deliveries, and general anaesthesia for less than 5 per cent. The obstetrical and anaesthetic staffs of our hospital believe that although lumbar epidural anaesthesia in obstetrics has some shortcomings it is the most desirable obstetrical anaesthetic available today. © 1960 Canadian Anesthesiologists.