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ANESTHESIOLOGISTS' PREFERENCES TOWARDS VISITOR PRESENCE DURING PLACEMENT OF NEURAXIAL LABOR ANALGESIA: A SURVEY
Abstract Number: F-03
Abstract Type: Original Research
INTRODUCTION: Labor pain relief with neuraxial blocks has become an integral part of modern anesthesia practice. Visitor presence during placement may be beneficial to the patient but is not without risk. With no specific guidelines existing, we sent a nationwide survey to anesthesiologists to determine views on this subject.
METHODS: An IRB approved survey was sent out to anesthesiologists practicing obstetric anesthesia via SOAP , several state anesthesia societies and to all anesthesiology residency programs. Over 1500 respondents were represented in the following categories:
--Neuraxial procedures per wk: <2; 2-5; 6-10; >10
--Years in practice: <2 years; 2-5 years; 6-15 years; >15 years
--Qualifications: Board Eligible (BE); Board Certified (BC); Board Eligible & OB Anesthesia Fellowship Trained (BE&F); Board Certified & OB Anesthesia Fellowship Trained (BC&F)
--Region: Northeast; Midwest; South; West
--Setting: Rural; Suburban; Urban
--Organization: Academic; Private; Government
RESULTS: QUESTIONS AND RESPONSES (Results are statistically significant; Chi square in SPSS.)
1) Preferred neuraxial technique? Epidural; Combined spinal epidural
-For all physician categories except “Qualification,” there was a 2:1 or greater favor for epidural analgesia. For “Qualification,” BE&F chose both options -equally.
2) Does the hospital have written policy regarding visitor presence during neuraxial procedure? Yes; No; I do not know.
-Physicians most knowledgeable of the policy by category were: “> 5 procedures/wk;” “>15 yrs. practice;” “BC&F;” and “Rural practice.”
3) In the absence of a policy would you allow a visitor? Yes; No
-All categories favored allowing a visitor by at least 2.5:1.
4) Favored visitor position: Sitting; Standing; Does not matter
-For all categories, combined “Sitting” and “Does not matter” responses were >85%.
5) Favored visitor view: No view; Partial view; Does not matter
-For all categories, “No view” was favored over either “Partial view” or “Does not matter” by 1.5:1 or greater.
6) Reason for allowing a visitor: Reduce patient anxiety; Reduce visitor anxiety; Visitor’s assistance needed; Fulfil patient’s request
-For all categories, combined “Reduce patient anxiety” and “Fulfil patient request” responses were 85% or greater.
7) Frequency of non-anesthesia influence on decision for visitor: Rarely; Occasionally; Often
-Except for “BE&F,” all categories recorded “Rarely” by 3:1 over other choices.
DISCUSSION: The ASA Task Force on Obstetric Anesthesia supports a multidisciplinary approach to create favorable maternal and fetal outcomes (Anesthesiology 2007;106:843-863). The majority of anesthesiologists agreed to have a visitor in the room during placement of neuraxial labor analgesia, but this may risk interference. Epidural analgesia and no view of the procedure as well as responses to most of the other survey questions showed statistically significant preferences.