Factors Affecting Anaesthesia Preference for Gynaecological Surgeries in a Nigerian Tertiary Institution

Abstract

Background: Gynecological surgeries are varied, can be complex, involve low and high-risk patients. Equipment, appropriate drugs and personnel are scarce, thus deciding on the mode of anaesthesia could occasionally be challenging. Objective: To review the factors that affect anaesthesia preference for gynaecological surgical procedures in our institution. Materials and Methods: This was a seven-year retrospective survey of the clinical records of all patients who had gynaecological surgeries in our center between January 2012 and December 2019. The following data were collected; age, indication for surgery, type of surgery, type of incision, site of surgery, nature of surgery (emergency or elective), type of anaesthesia, ASA status, and cadre of the anesthesiologist to see how they influenced the choice of anaesthesia. Data were analyzed using Statistical Package for Social Sciences (SPSS) version20 for simple frequencies and matched for type of anaesthesia. Results: A total of 2778 gynaecological operations were performed during the study period. There was an equal use of GA and RA. Emergency and endoscopic surgeries, pediatric patients, surgery on the fallopian tube, ovary or vulva, and anesthesia by a Nurse anesthesiologist influenced anaesthesia in favour of General Anesthesia (GA), while the elderly and middle age groups, abdominal myomectomy, cervical cerclage, vaginal hysterectomy, hysteroscopic adhesiolysis, myometrial, cervical or vaginal surgeries, Pfannenstiel incision, ASA I patients, physician anaesthetist and senior registrars influenced anaesthesia in favour of Regional anaesthesia (RA). Conclusion: All the factors analyzed influenced the choice of anaesthesia in line with best global practice. Where this was not the case as in the case of, ASA status and pediatric patients, the explanation could be found in the peculiar circumstance of our centre.