Improving the safety profile of anaesthetics delivered for Category 1 emergency Caesarean sections

Dave Patel1, Karunakaran Ramasamy2 
1. Specialty Registrar, Northampton General Hospital, United Kingdom
2. Consultant Anaesthetist, Northampton General Hospital, United Kingdom

Background
Category 1 Caesarean sections (LSCS) are undertaken if there is an immediate threat to the life of the mother or fetus. The NICE recommended standard is delivery within 30 minutes from the time that a category 1 section is declared. The preferred mode of anaesthesia for caesarean section is a regional technique. General anaesthesia (GA) is associated with an increased risk of maternal morbidity and mortality1.

Methods
We audited decision to delivery times in our trust and whether we were meeting standards and also took into consideration the type of anaesthetic administered to patients undergoing a category 1 LSCS. As the data collected highlighted an alarming number of patients undergoing GAs, we implemented some changes followed by re-audit to complete the cycle. Here, we present our results.

Results 
Our initial audit in 2013 demonstrated that over 90% of patients undergoing a category 1 LSCS met the NICE recommended 30 minute decision to delivery time frame. However, the most striking finding was that over 70% of these patients were undergoing GAs as opposed to a regional technique. 

We put forward some suggestions to implement changes to our practice. These included: 1. Immediately commencing intra-uterine resuscitation and transferring the patient to theatre allowing the anaesthetist to conduct a preassessment, 2. Perform a ‘rapid sequence spinal’ (if no regional block already in place). 3. Consider siting an early epidural in those patients who have a higher chance of requiring a LSCS. A re-audit then occurred in 2014/2015. We were pleased to discover that the GA rates had fallen profoundly and that over 70% of all category 1 LSCS patients received regional blockade (Figure. 1).
Figure.1  Proportion (%) of category 1 LSCS patients undergoing either a GA, spinal or epidural top-up (y axis).


Discussion
A regional technique is preferred for patients undergoing a LSCS. We were concerned about the vast quantity of patients receiving a GA for category 1 LSCS. Hence we introduced some ideas for contemplation by fellow peers. Following completion of the audit cycle we fulfilled our objective of reducing GA rates profoundly, thereby improving patient safety.

References
1.	CEMACH. Centre for Maternal and Child enquiries (www.cmace.org.uk/Publications-Press-Releases/Report-Publications/Maternal-Mortality.aspx).

Improving the safety profile of anaesthetics delivered for Category 1 emergency Caesarean sections: An audit of response times and mode of anaesthesia administered