Canadian Journal of Anesthesia, Vol 33, 651-656, Copyright © 1986 by Canadian Anesthesiologists' Society

Open Drop Ether Anaesthesia for Caesarean Section: A Review of 420 Cases in Nepal

¹ Department of Anaesthesia, University of Calgary, Calgary, Alberta, and Department of Obstetrics, Maternity Hospital, Kathmandu, Nepal

Address correspondence: Dr. J.R. Maltby, Department of Anaesthesia Foothills Hospital at the University of Calgary, 1403-29th Street N.W., Calgary, Alberta, Canada T2N 2T9.

Anaesthesia for Caesarean sections performed during 1982-83 at the Women's Hospital in Kathmandu, Nepal is reviewed, In a twelve-month period 535 Caesarean sections were performed, representing 7.36 per cent of 7,263 deliveries. Many pregnant women in Nepal do not have antenatal care and the mean haemoglobin of these mothers was 86 g·L^-1. In the absence of an on-call anaesthetist for obstetrics, more than 90 per cent of the anaesthetics were given by junior obstetric residents, using open drop diethyl ether without endotracheal intubation. Eleven patients developed postoperative chest infection; in none of these was there any suggestion of inhalation of gastric contents and all recovered uneventfully. Of the 18 maternal deaths in the 7,263 delivereies during this period, one occurred during Caesarean section. This was due to uncontrollable haemorrhage and was not attributable to the anaesthetic. For poor risk patients, and in unskilled hands, diethyl ether remains a remarkably safe anaesthetic.

Key Words: ANAESTHESIA: obstetric • ANAESTHETICS, VOLATILE: diethyl ether • COMPLICATIONS: preoperative anaemia