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Are we doing too many caesarean sections under general anaesthesia? A review at Royal Bolton Hospital
  1. N Katakam,
  2. N Greenwood,
  3. A Putland
  1. Royal Bolton Hospital, Bolton, UK

Abstract

Background In ‘Why Mother's Die 2000–2002’, it is stated that ‘There is unequivocal evidence that regional anaesthesia (RA) is safer than general anaesthesia (GA) for Caesarean sections (CS)’. Our primary aim was to determine whether all of the GA CS were appropriate, determine reason for GA, methods used for failed RA and quality of documentation.

Method Retrospective case-note review of 38 GA sections done from February 2008 to April 2008 was performed. Reasons for GALSCS (lower segment Caesarean section) and circumstances surrounding them were reviewed. Reason for GA was divided into four broad categories: Patient request, anaesthetic reason such as failed RA, obvious need for Grade 1 CS and unclear reason for urgency. All unclear reasons were discussed with a senior obstetric colleague.

Results 34 case notes were reviewed and 90.6% of cases had clear and valid reason. 6.3% were unclear obstetric reasons and 3.1% were unclear anaesthetic reason, main reason being inadequate documentation and inadequate communication.

Conclusion GA Sections are associated with higher maternal morbidity and should be avoided unless necessary. There should be a clear communication between obstetric and anaesthetic team regarding time available for delivery. In-utero resuscitation such as left lateral position, intravenous fluids and tocolysis can be used to avoid a GA CS.

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