Abstract
Purpose
To evaluate the experience of the operator and the time of epidural anesthesia as factors contributing to unintentional dural puncture (UDP).
Methods
In a prospective analysis of recorded cases of UDP the following variables were recorded: maternal height, weight, and weight gain, type of personnel providing epidural analgesia, number of attempts, and hour of the epidural procedure. Work time was divided into day-time (8 AM to 7 PM) and night-time (7 PM to 8 AM), according to the change of coverage of the delivery suite. Night-time was divided into first (7 PM to midnight) and second parts (midnight to 8 AM). Relative risk was used to compare the incidence of UDP among different work-times.
Results
A total of 1489 consecutive epidural procedures were considered. The incidence of dural puncture was 0.8% (12 cases). The relative risk was higher for night-time than day-time (risk ratio 6.33; 95% confidence interval, 1.39 to 28.80;P = 0.006). Seven cases were caused by three operators with poor expertise, and five by two skilled obstetric anesthesiologists.
Conclusion
Operator experience and hour of procedure appear to be two important risk factors of UDP The increased risk of UDP in night-work could result from human factors such as fatigue, sleep deprivation or interruption.
Résumé
Objectifs
Evaluer l’expérience de l’opérateur et l’heure de réalisation de l’anesthésie péridurale comme facteurs favorisant la survenue de brèches durales accidentelles.
Méthode
Analyse de cas de brèche durale accidentelle colligés de manière prospective. Les paramètres suivants ont été relevés: la taille, le poids et la prise de poids de la mère, le type de personnel ayant pratiqué l’analgésie péridurale, le nombre de tentatives, l’heure du repérage de l’espace péridural. La période de travail a été divisée en jour (de 8 h à 19 h), et en nuit (19 h à 8 h), en fonction de l’heure du changement d’anesthésiste. Enfin, la période de nuit a été divisée en première (19 h à minuit) et seconde parties (minuit à 8 h). La comparaison de l’incidence des brèches durales entre les périodes de travail a été faite par calcul du risque relatif.
Résultats
Un total de 1489 procédures péridurales ont été pratiquées. Lincidence globale de la brèche durale accidentelle était de 0,8% (12 cas). Le risque relatif était plus important en période de nuit comparée à la période de jour (risque relatif 6.33; intervalle de confiance à 95% 1.39 à 28.80;P = 0.006). Sept cas ont été causés par des opérateurs peu entraînés, et les 5 autres par des anesthésistes exerçant au service d’obstétrique.
Conclusion
Lexpérience de l’opérateur et l’heure de la procédure semblent être deux facteurs importants de risque de brèche durale accidentelle. Laccroissement du risque en période de nuit pourrait être dû à des facteurs humains tels que la fatigue, la privation de sommeil ou son interruption.
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Aya, A.G.M., Mangin, R., Robert, C. et al. Increased risk of unintentional durai puncture in night-time obstetric epidural anesthesia. Can J Anesth 46, 665–669 (1999). https://doi.org/10.1007/BF03013955
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DOI: https://doi.org/10.1007/BF03013955