General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study.
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Date
2020-09-21ICR Author
Author
Odor, PM
Bampoe, S
Moonesinghe, SR
Andrade, J
Pandit, JJ
Lucas, DN
Pan-London Perioperative Audit and Research Network (PLAN), for the DREAMY Investigators Group,
Type
Journal Article
Metadata
Show full item recordAbstract
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%).
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Subject
Pan-London Perioperative Audit and Research Network (PLAN), for the DREAMY Investigators Group
Humans
Succinylcholine
Propofol
Thiopental
Anesthesia, General
Obstetric Surgical Procedures
Cesarean Section
Logistic Models
Prospective Studies
Pregnancy
Adult
Middle Aged
England
Female
Airway Extubation
Language
eng
Date accepted
2020-08-14
Citation
Anaesthesia, 2021, 76 (4), pp. 460 - 471
Publisher
WILEY