Knowledge of South African anaesthesia registrars of the theory and practice of spinal anaesthesia for caesarean section

Ras, Willem

Knowledge of South African anaesthesia registrars of the theory and practice of spinal anaesthesia for caesarean section

Thesis / Dissertation

2023

Abstract

Background Adequate documentation of details relating to spinal anaesthesia for caesarean section is important, both to ensure a safe and pleasant experience for the parturient, and to provide evidence that an acceptable standard of care was applied in the event of subsequent medicolegal action. On the basis of recent research conducted at the University of Cape Town, documentation of details of spinal anaesthesia at a level 2 obstetrics hospital was inadequate. In the aforementioned study, 12 main aspects were regarded as essential for documentation. It was hypothesised that a contributing factor to poor record-keeping was inadequate knowledge of the practitioner, of the theory and practice of spinal anaesthesia. Methods South African anaesthesia registrars (Universities of Cape Town, Free State, KwaZulu-Natal, Pretoria, Witwatersrand, Sefako Makgatho, Walter Sisulu, Stellenbosch) who are members of the South African Society of Anaesthetists (SASA) were contacted and invited to engage in an online completion of the questionnaire. A single best answer multiple choice questionnaire (20 questions) encompassing the following important aspects of documentation was utilised to assess knowledge of spinal anaesthesia for caesarean section: 1 Applied anatomy and physiology. 2 Equipment considerations. 3 Factors influencing block height. 4 Testing of the block, including management of breakthrough pain. 5 Pharmacology. Demographic details of participants were also documented. Data were transcribed from the questionnaires to an Excel spreadsheet, and coded appropriately for analysis by statistical software (MedCalc® Statistical Software version 20.218 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2023). The Shapiro-Wilk test tested for normal distribution. Subgroup comparisons within demographic 8 categories were performed using non-parametric tests (Mann-Whitney-U test for two independent samples and the Kruskal-Wallis one-way analysis of variance test for multiple independent groups). An alpha value < 0.05 was regarded as indicating statistical significance. Backward multiple linear regression analysis was performed with participant scores as the dependent variable and demographic variables as the independent variables. Backward logistic regression analysis was performed with passed/failed as the dependent variable and demographic variables as the independent variables. Results A total of 126/400 responses were received, with a response rate of 31% and margin of error 7.3%. Participants' questionnaire scores were not normally distributed. The median score was 50% (95% confidence interval (CI) 45% to 50%; range 20% to 75%). Overall, a knowledge score greater than 50% was achieved by 51.5% of registrars and 48.4% achieved lower than 50% average score. Secondary analysis showed weak associations between demographic variables and the scores achieved. Conclusions This questionnaire revealed a considerable knowledge deficit amongst anaesthesia registrars in South Africa of various aspects of the practice of SA for CS. Areas of training, including applied anatomy and physiology, equipment considerations, factors affecting block height, testing of block height and management of breakthrough pain, and pharmacology, require focused educational intervention, including simulation. This would improve documentation on the anaesthesia record and the quality of the experience of SA for CS for patients, and reduce medicolegal proceedings and ultimately patient morbidity and mortality.

Keywords

Medicine

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