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FACTORS RESULTING IN UNDER UTILIZATION OF PEDIATRIC SPINAL ANAESTHESIA IN SOUTH PUNJAB( PAKISTAN).

1.PROF. HAQ DAD DURRANI, 2. Dr. Sairah Sadaf Sadaf, 3.Dr. Syed Aushtar Abbas Naqvi;, 4.DR. AMJAD Siddique, 5. DR. Manzoor Hussain Bajwa.

Abstract
Abstract;
Background; Spinal anesthesia in children a useful alternative to general anesthesia, is not usually practiced in most of the hospitals of South Punjab.
Aims: To evaluate the utilization of spinal anesthesia in children in South Punjab (Pakistan) and to discover the elements preventing its use in children.
Materials and Methods:-
Questionnaire was delivered to all forty seven F.C.P.S. anesthesiologists working in South Punjab vide e mail, whatsapp to them or their near ones. Among 47 anesthesiologists, 38 (80.85% %) responded. Questionnaire consisted of 3 components. All the participants were asked to reply First components regarding demographic data.
If the participants claim not administering spinal in children, only then they needed to fill second and third components. In second component, structured questions with scale 1 to 5 (1 suggests strongly disagree and 5 consider strongly agree with the factor). In the third component, the participant had open choice to write three most important factors (most important, second most and third most) prohibiting administration of spinal in children.
Results: All the forty seven anesthesiologists with terminal qualification working in South Punjab were included in this survey. Thirty eight (80.85 %) responded to the questionnaire. Demographic information showed 33/38 (86.84 %) males, 05/38 (13.16 %) females, mean age 44.3411.06 years, mean of total experience in anesthesia 17.039.12 years and mean of experience after post graduation 8.016.85 years. Among the 38 respondents, 03/38 (7.88 %) have been administering spinal anesthesia in children and 35/38 (92.12 %) do not choose spinal in children even they use spinal in 59.0618.68% of adult population undergoing anesthesia.
Our quantitative data reflects that lack of expertise/training/guidance (4.690.83) is the most common cause prohibiting anesthesiologist for administering spinal anaesthesia in children followed by risk of high/total spinal (4.141.31), lack of cooperation of child (3.831.34), risk of spinal cord injury (3.711.51), difficulty in assessment of block (3.341.64). Less common factors avoiding pediatric spinal include objection by family, objection by surgeon and lack of proper recommendations.
In response to the open ended questions, the largest group of participants consider lack of expertise/training/guidance (9/35=25.71%), followed by lack of cooperation of child 8/35(22.86%), risk of spinal cord damage 5/35(14.28%) and risk of high/total spinal 3/35(8.57%) and objection by family 3/35(8.57%) most important factors for avoiding spinal anesthesia in children. Other factors referred by a few participants include objection by surgeon, postdural puncture headache, neurological complications, short duration, not recommended and not acceptable by society.
Conclusions:- Spinal anesthesia in children is administered by three consultants (7.88%) with highest qualifications in South Punjab. Lack of expertise/training/guidance was considered the most important factor followed by risk of high spinal, lack of cooperation of child, risk of spinal cord damage prohibiting spinal anesthesia in children. Some respondents also consider objection by family, objection by surgeon, neurological complications, short duration and post Dural puncture headache.

Key words: Pediatric Spinal anesthesia, under utilization, South Punjab (Pakistan).






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