A survey of anaesthetic techniques used for caesarean section in the UK in 1997 (original) (raw)
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International journal of obstetric anesthesia, 1998
Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients w...
Retrospective Evaluation of the Anaesthetic Method Used in Caesarean Sections
Bezmialem Science, 2015
Objective: The goal of this study was to evaluate the anaesthetic method used in patients who have undergone caesarean section. Methods: The anaesthetic reports that belong to the women who underwent caesarean section between the years 2014 and 2015 were evaluated in terms of the demographic data, anaesthetic methods, and reported complications. Results: Although 299 patients received general anaesthesia, 75 patients received regional anaesthesia during caesarean section. Mortality was not observed in any patient. Conclusion: Although regional anaesthesia is currently being used mostly in many countries for caesarean sections, our patients chose the general anaesthesia. Making the method of anaesthesia depend on patients' preferences with the exception of some special conditions such as patients' fear and anesthesiologist's additional aliments might have a role in this circumstance.
Anesthesia-Related Maternal Mortality in the United States: 1979–2002
Obstetrical & Gynecological Survey, 2011
OBJECTIVE: To examine 12 years of anesthesia-related maternal deaths from 1991 to 2002 and compare them with data from 1979 to 1990, to estimate trends in anesthesia-related maternal mortality over time, and to compare the risks of general and regional anesthesia during cesarean delivery.
Anaesthesia for emergency caesarean section
BJOG: An International …, 1990
The Report on Confidential Enquiries into Maternal Deaths in England and Wales 1982-84 (Department of Health 1989) recommends early involvement of the anaesthetist in women having emergency caesarean sections and the use of epidural anaesthesia in preference to general anaesthesia. In an observational prospective study the need for emergency abdominal delivery could be anticipated in 87% of 360 consecutive emergency caesarean sections. Early establishment of epidural analgesia allowed extension, to an appropriate level for the surgery, in 70%. The duty anaesthetist accompanying the obstetric team on three wardrounds a day could be forewarned of anticipated problems in most women who are eventually delivered abdominally. Appraisal of the feasibility of improving preoperative assessment and the provision of epidural anaesthesia was one objective of a prospective study of emergency caesarean sections. Such improvements are limited by the quantity and quality of anaesthetic manpower available, given the very large number of obstetric units requiring anaesthetic services and the competing needs of other surgical disciplines (Morgan 1987). Minor organizational changes that allow early involvement of the anaesthetist with the women in labour could increase maternal safety. Subjects and methods A prospective observational study of 360 consecutive patients delivered by emergency caesarean section was undertaken to assess a policy of recommending epidural analgesia early in Institute of Obstetrics & Gynaecology, Queen
Anaesthetic management of obstetric emergencies
Indian Journal of Anaesthesia
Obstetric emergencies are a challenge both for the obstetrician and the anaesthesiologist. The incidence of caesarean sections as per the National Family Health Survey published in 2015-16 was 17.2%. In 7.6% of cases, the decision to conduct a caesarean section was taken after the onset of labour pains. Caesarean sections are classified depending on the urgency into four categories. The target decision to delivery interval for category 1 caesarean section is less than 30 min. This is used as an audit tool for the efficiency of an obstetric service. The management of these emergencies involves a rapid assessment, with minimal investigations. Although general anaesthesia is considered to have higher morbidity and mortality, category 1 caesarean sections may still warrant this technique. Rapid sequence spinal anaesthesia is replacing general anaesthesia for many of the category 1 indications. In category 2 and 3 caesarean sections, spinal anaesthesia still remains the technique of choice. Failed intubation, failed neuraxial block, extensive neuraxial block, awareness under anaesthesia, thromboembolism, amniotic fluid embolism, haemorrhage and maternal collapse are some of the complications. Haemorrhage is said to be the leading cause of mortality worldwide.
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.