A survey of anaesthetic techniques used for caesarean section in the UK in 1997 (original) (raw)
International Journal of Obstetric Anesthesia, 2010
Background: Anaesthetic-related maternal deaths have largely been attributed to complications of general anaesthesia. In our unit a retrospective audit conducted between 1997 and 2002 showed a 9.4% conversion rate to general anaesthesia for caesarean sections amongst women with epidural catheters in-situ. The Royal College of Anaesthetists has stated that <3% of cases should need conversion to general anaesthesia. To improve our figures, from 2004 to 2007 we prospectively audited all caesarean sections requiring general anaesthesia. Methods: Data were collected on the number of caesarean sections, initial anaesthetic technique used, need for conversion either pre-or intra-operatively and the use of labour epidural analgesia, where an epidural had been in-situ. Results: There were 2273 caesarean sections during the audit period. Neuraxial anaesthesia rates were for elective cases 95.3% , 96.3% (2005), 98.3% (2006) and 98.2% (2007) and for emergency cases 82.3% (2004), 88.6% (2005), 87.0% (2006) and 85.7% . Common reasons given for not using a regional technique were urgency of delivery (category 1) or anticipated large blood loss. Conversion rates from regional to general anaesthesia for elective cases were 0.. Improvements were seen in all but category-1 caesarean sections. Conclusions: Prospective audit has been associated with improved rates for neuraxial anaesthesia and reduced need for conversion to general anaesthesia in all but category-1 caesarean sections. The Royal College of Anaesthetists standards may need to be reviewed to become category-specific.
Anaesthesia, 2020
There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).
Retrospective Evaluation of Anaesthetic Techniques for Caesarean
Turkish journal of anaesthesiology and reanimation, 2015
This study aimed to evaluate the maternal, foetal and neonatal effects of anaesthetic techniques used in caesarean sections (C/S) retrospectively over 6 years at the Hospital of Medical School of Dokuz Eylül University and to compare the results with the literature from Turkey and developed countries. After obtaining approval from the ethics committee, anaesthetic and gestational data from all caesarean operations performed over a 6-year period between 2005 and 2010 was retrospectively obtained from hospital archives. During this period, a total of 10,819 labours was conducted and C/S ratio was 55% with 5953 patients. General anaesthesia was performed in 1479 patients (24.8%) and regional anaesthesia was performed in 4474 patients (75.2%) [Spinal anaesthesia for 1203 patients (26.9%), epidural anaesthesia for 830 patients (18.5%) and combined spinal-epidural anaesthesia for 2441 patients (54.6%)]. In 2010, regional anaesthesia ratio increased to 84.6%, whereas in 2005, it was 63.8%....
PLOS ONE, 2018
Background While foetal distress is typically associated with ischaemic injury, few studies have assessed neonatal morbidity for emergency caesarean section. Moreover, the decision of the anaesthetic technique may be of paramount importance in emergency caesareans, because of the limited time and increased risk. We aimed to evaluate the effect of the anaesthetic technique on neonatal morbidity in emergency caesarean indicated for foetal distress. Methods This was a single-centre, prospective observational study, conducted between July-2015 and December-2015. The study enrolled parturient with indication for emergency caesarean section after diagnosis of foetal distress, who received either regional or general anaesthesia. The outcome measures were: 1, 5-minute Apgar scores; umbilical blood pH; length of hospitalization; and morbidity, defined as a 5-minute Apgar score <7, need for mechanical ventilation, admittance to a neonatal intensive care unit, or respiratory insufficiency symptoms. Results 61 patients were included in the study, of whom 31 received regional anaesthesia. Neonatal morbidity was noted in 5 and 9 cases with regional and general anaesthesia, respectively. The 1-minute Apgar score was significantly lower(p = 0,045) for cases with general anaesthesia, which was not true for the 5-minute Apgar score. Regional anaesthesia was non-significantly associated with shorter length of hospitalization, lower incidence of morbidity, and higher umbilical blood pH. When we take regional anaesthesia cases as a reference point, we detected that general anaesthesia cases are showing 2,2 times more morbidity risk. But these results did not reach any statistically significant levels.
IOSR Journal of Dental and Medical Sciences, 2014
Objective: This study is to ascertain the preferred choice of anaesthetic technique and their reasons, among pre gnant women schedule for caesarean section during preoperative visit in Federal Teaching Hospital, Gombe. Methodology: This was a three year prospective study [from June, 2010-May, 2013] of pregnant women sched uled for either elective or emergency caesarean section. During the preoperative visit, patients were counselled and consent obtained on either regional or general anaesthesia and their reasons for the choice documented. Results: A total of 1,350 women were interviewed during the three years period of the study.]The total of four h undred and sixty one patients (n=461, 34.1%) were scheduled for emergency caesarean section, while eight hun dred and eighty nine patients (n=889, 65.9%) were scheduled for an elective caesarean sections. They were age d 17-40 years with the mean age of 27.84 +/-4.43 years. The parity ranged from 1-12. Majority of the patients 9 45 (70%) preferred regional anaesthesia, while 405 (30%) preferred general anaesthesia The common reasons f or their preference to regional anaesthesia include early contact with their babies, fear of death from general a naesthesia, want to know what is going on in the theatre, general anaesthesia is more dangerous, patient being awake, reduced blood loss, cheaper and well tolerated however, others preferred general anaesthesia because o f fears of the complications of regional anaesthesia e.g. backache, headache etc. Conclusion: We conclude that regional anaesthesia is the preferred technique of choice for most pregnant wom en undergoing caesarean sections in our centre. Detail preoperative review with emphases on counselling of the patients by the anaesthetists on the advantages of regional anaesthesia over the general anaesthesia will encou rage the high preference of regional over general anaesthesia. We therefore, recommend that preoperative revie w should be encouraged in all hospitals and in all patients undergoing either emergency or elective caesarean s ections.
Towards effective obstetric anaesthetic audit in the UK
International journal of obstetric anesthesia, 1999
Obstetric audit is multidisciplinary, but maternal mortality data represent the only national obstetric anaesthetic audit currently available in the UK. Maternity and neonatal audit is progressing towards the collection of both numerator and denominator data in order to compare local, regional and national figures. Obstetric anaesthetists as a professional group play a significant role in maternity care and have in the past developed a minimum data set. Such a set now requires revision of items, agreement on definitions and integration with national projects. Since local and regional obstetric anaesthesia data collection systems are available, albeit in various manual or computerized forms, this is an achievable target. A standard maternity and neonatal data set which incorporates obstetric anaesthetic clinical items could offer a qualitative comparison of process variables and outcome, but should be under professional anaesthetic control. In addition, the process may enable profess...
Bezmialem Science, 2020
Amaç: Sezaryen ile doğumlarda rejyonal anestezi çoğunlukla tercih edilir. Bu çalışmada genel, epidural ve spinal anestezi tekniklerinin fetal ve maternal etkileri açısından karşılaştırılması amaçlandı Yöntemler: Sezaryen ile doğum yapan gebeler rastgele üç gruba ayrıldı: genel anestezi (GA), epidural anestezi (EA) ve spinal anestezi (SA). APGAR skoru, fetal kan gazı seviyesi, serbest O2 gereksinimi ve pozitif basınçlı ventilasyon, fototerapi gereksinimi, bilirubin seviyesi ve kilo kaybı kaydedildi. Ayrıca ilk emzirme zamanı, perioperatif kanama, kristalloid gereksinimi, efedrin tüketimi, ilk analjezik gereksinimi, ilk defekasyon ve mobilizasyon süresi ölçüldü. Bulgular: APGAR skorları ve SpO2 GA grubunda düşüktü (p <0.05). Altı yenidoğanda O2 desteği ve pozitif basınçlı ventilasyon gerekti ve GA grubundan bir yenidoğan entübe edildi ve NICU'ya transfer edildi. İlk emzirme zamanı GA grubunda diğer gruplara göre uzadı (p <0.05). Yenidoğanların doğum sonrası 48 saatlik kilo kaybı EA ve SA gruplarında GA grubundan daha yüksekti (p <0.05). Peropertif kanama GA grubunda daha yüksekti. SA grubunda, efedrin ve sıvı gereksinimleri daha yüksekti ve mobilizasyon süresi daha kısa idi (p <0.05). İlk analjezik gereksinimi ve ilk defekasyon süresi EA grubunda daha kısaydı (p <0.05). Objective: Regional anaesthesia is mostly preferred for elective caesarean delivery. This study aimed to compare general, epidural and spinal anaesthesia techniques in terms of their foetal and maternal effects. Methods: Parturients undergoing elective caesarean delivery were randomly divided into three groups: general anaesthesia (GA), epidural anaesthesia (EA), and spinal anaesthesia (SA). The APGAR score, foetal blood gas level, free O2 requirement and positive-pressure ventilation, phototherapy requirement, bilirubin level and weight loss were recorded. The time to the first breastfeeding, perioperative bleeding, crystalloid requirement, ephedrine consumption, first analgesic requirement, the time of defaecation and mobilization were also measured. Results: The APGAR scores and SpO2 were lower in the GA group (p<0.05). Six newborns required O2 supply and positive-pressure ventilation and one newborn from the GA group was intubated and transferred to the NICU. The time to first breastfeeding was prolonged in the GA group compared with the other groups (p<0.05). Postnatal 48-hour weight loss of the newborns was higher in the EA and SA groups than in the GA group (p<0.05). Peropertive bleeding was higher in the GA group. In the SA group, ephedrine and fluid requirements were higher and the mobilization time was shorter (p<0.05). The first analgesic requirement and defaecation time were shorter in the EA group (p<0.05).
Medical Journal of Pokhara Academy of Health Sciences, 2018
Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital. Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded. Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anest...
Update on obstetrical anaesthesia
Canadian Anaesthetists’ Society Journal, 1986
This Continuing Medical Education article is intended to review some of the current topics of interest in obstetrical anaesthesia. Since a complete review of the whole topic has now achieved text book status, a discussion of some of the more controversial areas is presented. The first part of the article deals with regional anaesthesia, while the second part covers other methods of analgesia and anaesthesia. Finally a short discussion on the problems of "informed consent" is included.