Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
Key issues and barriers to obstetrical anesthesia care in Ontario community hospitals with fewer than 2,000 deliveries annually.
Lack of the availability of anesthesia services may be a factor in the closure of maternity services in rural Canada, limiting the capacity for Cesarean delivery and intensifying the urbanization of maternity care. Unlike other professions involved in maternal newborn care, health services research in obstetrical anesthesia is virtually non-existent. This study explored barriers physicians encountered in providing obstetrical anesthesia care in Ontario community hospitals experiencing low volumes (fewer than 2,000) deliveries per annum (PA). Solutions proposed by a mixed focus group of academic and community hospital leaders were also described. ⋯ Physicians in community hospitals face significant barriers in the provision of obstetrical anesthesia care. These are greatest among FP/GP anesthetists and in rural hospitals where physician shortages and lack of supports threaten provision of services in some hospitals. Local context-specific and systems-level solutions are required.
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The purpose of this Continuing Professional Development module (CPD) is to update clinicians regarding a systematic approach for anticipated difficult airway management. ⋯ Airway management should be approached systematically, always keeping in mind the importance of uninterrupted oxygenation and ventilation, especially when difficulties are anticipated. Supraglottic devices can play an important role in the management of the difficult airway, whether used for the duration of surgery or inserted as an aid to intubation.