Obstetrics Felicity Plaat Consultant Anaesthetist

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Presentation transcript:

Obstetrics Felicity Plaat Consultant Anaesthetist Queen Charlotte’s and Hammersmith Hospitals

Denominator data % all GAs given % AAGA reports

HES: ‘These represent unlikely events’ Denominator data Obstetric cases not analysable 352 000 126 000 obstetric cases analysable 226 000 CS non-CS 95 000 131 000 regional GA GA regional 87 000 8000 9000 122 000 NMB NMB 8000 6120 HES: ‘These represent unlikely events’

Characteristics of obstetric cases variable number % Non elective 11 79 Out of hours [01.00- 08.00] 9 64 Airway difficulty 5 36 Obesity 4 29 Rapid sequence induction 13 92 Low dose of thiopentone 7 50 N2O not used 6 43 End-tidal monitoring not used 4 29

The obstetric gap Induction agent: thiopentone v propofol/ dose Airway difficulty MAC used Increased cardiac output

Indication for general anaesthesia? In two cases of AAGA regional anaesthesia was considered contraindicated. In 4 cases general anaesthesia was used when regional anaesthesia failed. In 4 cases there was no obvious indication for general opposed to regional anaesthesia

Episodes of awareness At induction Brief Rapidly reported 3 cases adverse psychological sequelae 1 case litigation A patient with severe pre-eclampsia required cat 2 CS out of hours after several hours of stabilisation by the multidisciplinary team. At induction cefuroxime was given instead of thiopentone. In recovery she reported being aware of laryngoscopy and intubation but she was unconcerned as she trusted the doctors

Recommendations Discuss AAGA as part of informed consent Changes to GA technique Plan for maintenance of anaesthesia during airway difficulties Failed regional is a risk factor for other complications Caution with antibiotic syringes