Development of Clinical Practice Guideline for Cesarean Section in Anesthetic Department, Surin Hospital

Abstract

Background: Hypotension during anesthetic procedure is ล common complication and cause insufficient blood supply to various organs hence decreases tissue oxygenation. A quality indicators review of anesthetic department in 2010 revealed that rate of hypotension during spinal anesthesia for cesarean section was 39.9 percent.
Objects: To evaluate outcome of clinical practice guideline for the prevention of hypotension during spinal anesthesia for cesarean section and determine satisfaction of nurse anesthetists and patient the clinical practice guidelines.
Setting: Surin hospital
Study Design: Research and development study
Method: The sample was purposively selected in group of anesthesiologists and obstetricians, nurse anesthetists and patients. The study was conducted from October 2010 to December 2011. The Study consisted of 3 phases. The first phase was background survey of twenty-two nurse anesthetists focused on prevention of hypotension during spinal anesthesia for cesarean section. During the second phase, a clinical practice guideline was therefore developed for hypotension prevention during spinal anesthesia for cesarean section. The third phase was an outcome evaluation of the clinical practice guidelines. Data analysis was presented by mean and percentage.
Results: The clinical practice guidelines for the prevention of hypotension during spinal anesthesia for cesarean section were included 1) Preparation of patient for spinal anesthesia. 2) Hypotension prevention protocol 3) Patient monitoring protocol during spinal anesthesia 4) Incidence report guideline. The outcome evaluation found that incidence of hypotension during spinal anesthesia for cesarean section was 19.6% while more than 80% of nurse anesthetists satisfied with this clinical practice guideline.
Conclusions: According to the result; this developed clinical practice guidelines was considered as an effective quality assurance of anesthesia procedure. The new clinical practice guideline required the participation of practitioners for guide line development through sharing the experience and opinion in all aspect to produce the convenient and explicit protocols.