A national survey of obstetric anaesthesia guidelines in the UK

McGarrity, Larissa A.; O’Connor, Robert; Young, Steven J.

doi:10.1016/j.ijoa.2008.04.006

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…A recent survey of availability of obstetric anaesthetic guidelines recommended by the Association of Anaesthetists ⁄ Obstetric Anaesthetists' Association found 100% availability of guidelines for haemorrhage and eclampsia, 74% for the management of high regional block and 82% for maternal resuscitation [10]. Our survey results are similar although do not reach 100% for the first two topics.…”

Section: Discussioncontrasting

confidence: 42%

Category‐1 caesarean section: a survey of anaesthetic and peri‐operative management in the UK*

et al. 2010

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A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%-80% [6%-100%]), 12% (9%-16% [3%-93%]), 4% (2%-5% [<1%-18%]), for category-1 caesarean section, categories 1-3 (non-elective ⁄ emergency) and category-4 (elective) caesarean section, respectively. The main operating theatre for caesarean section is on the delivery suite in 151 (88%) units, and 112 (66%) units also have a second theatre in the same location. One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline's recommended decision-delivery intervals for category-1 ( £ 30 min), category-2 ( £ 30 min) and category-3 ( £ 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units. A four-point classification of urgency of caesarean section was described by Lucas et al. [1], and was recommended for national use by the National Institute for Clinical Excellence (NICE) in 2004 [2]. 'Emergency' and 'elective' caesarean section equate to categories 1-3 and category 4 respectively. Category 1, the most urgent, is defined as 'immediate threat to life of woman or fetus'. The relative risk of maternal death for category-1 caesarean section was observed to be 15 times that of category-3 caesarean section, although it is not clear whether this is due to pre-existing maternal pathology, or the indication for caesarean section [3]. In emergency situations, there is a greater need for clear communication, teamwork and consistent practice. We wished to establish the organisational factors including staffing, anaesthetic practice and the existence of specific guidelines that may have an impact on management of category 1 caesarean sections in consultant-led obstetric units in the UK. MethodsA questionnaire was developed by the authors and reviewed by the Obstetric Anaesthetists' Association's Audit Subcommittee. The Subcommittee approved this as a national survey (number 63 -http://www.oaaanaes.ac.uk). Contact details for lead obstetric anaesthetists in 245 maternity units were provided and a questionnaire was sent by post (Appendix). The questionnaire asked about labour ward and operating Anaesthesia, 2010Anaesthesia, , 65, pages 362-368 doi:10.1111Anaesthesia, /j.1365Anaesthesia, -2044Anaesthesia, .2010 362Journal compilation Ó 2010 The Association of Anaesthetists of Great Britain and Ireland theatre organisation, staffing levels, the categorisation of urgency used for caesarean section in each unit, the choice of anaesthetic used according to urgency, and the existence of guidelines in each unit for anaesthesia, intraute...

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Section: Discussioncontrasting

confidence: 42%

Category‐1 caesarean section: a survey of anaesthetic and peri‐operative management in the UK*

et al. 2010

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“…Though evidence is conflicting, the motivation for intrauterine resuscitation has been described in detail . Similar to our findings, international studies also show limited knowledge and limited local guidelines on intrauterine resuscitation . Anaesthesiologists working with obstetric patients should be knowledgeable about intrauterine resuscitation as foetal distress can be augmented by the initiating of neuraxial anaesthesia.…”

Section: Discussionsupporting

confidence: 69%

Urgency of caesarean section, grading, alarm chain and intrauterine resuscitation – a survey of Scandinavian practice

Wildgaard

Ismaiel

Hetmann

2017

Acta Anaesthesiol Scand

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Our survey of Scandinavian specialists indicate emergency CS practise differs from United Kingdom practices in several aspects; general anaesthesia is by the majority of Scandinavian specialists reported as the default choice for emergency CS and benchmark for decision-to-delivery interval is < 20 min. Nomenclature used for classification showed considerable variance in Norway and Sweden compared to Denmark. No joint Scandinavian guidelines exist.

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“…In units with 5000-7500 deliveries, only 3/8 (38%) units had such coverage. There were 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) labor rooms in each hospital. All units had computerized data collecting systems; however, only 9 units used this system to record complications.…”

Section: Resultsmentioning

confidence: 99%

“…8 In comparing obstetric anesthesia services within Israel with other developed countries, the overall use of labor epidural analgesia is higher. 3,9,10 A 1999 German survey reported a labor epidural analgesia rate less than 10%, with 10% of institutions not offering labor epidural analgesia. 11 Some European countries have reported high rates of labor epidural analgesia use, including 65% in Flanders, 12 and 61.6% in France, 13 with higher rates in teaching hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 These documents provide standards for resident and post-graduate training in obstetric anesthesia, 2 guidelines for specific obstetric anesthesia practices 1,2 and mechanisms to assess guideline implementation. 3 In the UK, a statement delineates acceptable levels of obstetric anesthesia care, such as staffing levels in the labor unit, the timeliness of labor analgesia, and the need to separate elective versus unscheduled anesthesia workloads on the labor unit. 2 A UK national obstetric anesthesia database was initiated to assess the provision of obstetric anesthesia and the incidence of associated complications.…”

Section: Introductionmentioning

confidence: 99%

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