393 KB43 KB192920262024Stopar Pintarič, TatjanaStopar Pintarič, TatjanaVerdenik, Ivanštevilka:9-10letnik:93str. 329-338DOI:10.6016/ZdravVestn.3518ISSN:1318-0347COBISSID:212084995URN:URN:NBN:SI:doc-3U09ZASNslSlovensko zdravniško društvoZdravniški vestnikcarski rezepiduralna anestezijaevropski standardimeperidinpodročna anestezijaremifentanilPodročna anestezija/analgezija po 14 slovenskih porodnišnicah v obdobju 2013–2021| kje smo in kam gremo?| Regional anaesthetic techniques in 14 Slovenian obstetric units between 2013 and 2021| where are we and where are we going?|Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (> 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in > 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of >10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departmentsIzhodišča: Minimalni evropski standardi za porodniško anestezijo in analgezijo, ki so bili izdani leta 2020 na pobudo Evropskega združenja za anesteziologijo in intenzivno terapijo, priporočajo, da se področne tehnike za carski rez in lajšanje porodne bolečine uporabljajo v čim večjem številu po vseh oddelkih, kjer se izvaja porodniška anestezija in analgezija. Namen članka je zato ugotoviti, kolikšen je delež carskih rezov v področni anesteziji in kolikšen je delež anesteziološko vodenih analgezij (epiduralna analgezija in remifentanil-PCA) ter porabe meperidina (dolantina) v 14 slovenskih porodnišnicah v letih 2013–2021. Metode: Analizirali smo podatke slovenskega Nacionalnega perinatalnega informacijskega sistema (NPIS) v obdobju 2013–2021. Rezultati: Spinalna anestezija je bila glavna metoda (> 50 % porodnic) za elektivni carski rez v polovici slovenskih porodnišnic (7 od 14). Za nujni carski rez so bile področne anestezijske tehnike (spinalna in epiduralna) zastopane pri > 50 % porodnic v 3 slovenskih porodnišnicah. Delež epiduralne analgezije je bil > 10 % v 8 porodnišnicah, a s trendom naraščanja v 9 od 14 porodnišnic. Remifentanil-PCA se je rutinsko uporabljal v 6 slovenskih porodnišnicah. Poraba meperidina je zato padla v vseh porodnišnicah razen v 1. Zaključek: V zadnjih 10 letih beležimo velik napredek porodniškoanesteziološke stroke v Sloveniji, ki se kaže v povečanem deležu carskih rezov v področni anesteziji ter v anesteziološko vodenih analgezijah. Kljub temu pa med slovenskimi porodnišnicami obstajajo razlike v anesteziološki praksi, s čimer bi morale biti nosečnice vnaprej seznanjene, da bi lahko izbrale porodnišnico glede na vrsto in dostopnost anesteziološko vodenih analgezij ter drugih prednostnih načinov vodenja poroda. Da bi preprečili razlike v kakovosti in dostopnosti anestezioloških storitev, bi morali oddelki, kjer se izvaja porodniška anestezija in analgezija, izvesti dodatne strokovne in kadrovske okrepitve za uvedbo stalnih porodniškoanestezijskih timov za nudenje obporodne analgezije 24/7, da se izpolnijo minimalni evropski standardiTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo