General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study.

Published on Apr 1, 2021in Anaesthesia5.739
· DOI :10.1111/ANAE.15250
Peter M. Odor10
Estimated H-index: 10
S. Bampoe11
Estimated H-index: 11
+ 748 AuthorsA. Wickham1
Estimated H-index: 1
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%).
#1K. Au (UBC: University of British Columbia)H-Index: 1
#2W. Shippam (UBC: University of British Columbia)H-Index: 2
Last. Anthony Chau (UBC: University of British Columbia)H-Index: 13
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Using biased-coin sequential allocation, we sought to determine the effective time interval in 90% of healthy parturients to achieve a target endpoint end-tidal oxygen of >/= 90% using standard flow rate facemask and high-flow nasal oxygen. Eighty healthy parturients were randomly assigned to standard facemask (n = 40) or high-flow nasal oxygen (n = 40) groups; half of the parturients in the high-flow nasal oxygen group also used a simple no-flow facemask to minimise air entrainment. The effecti...
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#1Peter M. Odor (St. George's University)H-Index: 10
#2S. Bampoe (UCLH: University College Hospital)H-Index: 11
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Abstract Background Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research study was designed to address practical and methodological challenges for studying AAGA in an obstetric cohort. Methods This is the trial protocol of a prospective, multicentre cohort st...
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Abstract Background Current evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. Methods One hundred and eighty women were randomly assigned. The primary outcome was the time to tracheal intubation. Secondary outcomes were the time to the best laryngeal view, grade of Co...
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#1Leigh White (UQ: University of Queensland)H-Index: 10
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Abstract Introduction The adverse effects of induction opioids on the neonate are poorly characterised. The study aim was to investigate whether induction opioids can be used in caesarean section without adversely affecting the neonate. Methods Six databases were systematically searched from inception until January 2019. Included studies compared induction opioids and placebo in caesarean section. Results were presented as odds ratios (95% confidence intervals) for dichotomous outcomes and weigh...
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#1W. ShippamH-Index: 2
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: High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min-1 oxygen flow) via nasal prongs with standard 15 l.min-1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min t...
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Abstract Background UK national anaesthetic activity was studied in 2013 but weekend working was not examined. Understanding changes since 2013 in workload and manpower distribution, including weekends, would be of value in workforce planning. Methods We performed an observational survey of NHS hospitals' anaesthetic practice in October 2016 as part of the 6th National Audit Project of the Royal College of Anaesthetists (NAP6). All cases cared for by an anaesthetist during the study period were ...
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#1Tim Cook (RUH: Royal United Hospital)H-Index: 9
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#1M. R. Checketts (Dund.: University of Dundee)H-Index: 1
#2R. Alladi (Royal College of Anaesthetists)H-Index: 1
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Summary This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are inc...
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PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics t...
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#1Rachel J. Kearns (Glas.: University of Glasgow)H-Index: 9
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BACKGROUND The fetus is vulnerable to maternal drug exposure. We determined associations of exposure to spinal, epidural, or general anesthesia on neonatal and childhood development outcomes during the first 1000 days of life. METHODS Population-based study of all singleton, cesarean livebirths of 24+0 to 43+6 weeks gestation between January 2007 and December 2016 in Scotland, stratified by urgency with follow-up to age 2 years. Models were adjusted for: maternal age, weight, ethnicity, socioeco...
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