There is overwhelming evidence that regional anaesthesia (RA) is safer than general anesthesia (GA) for a caesarean section (CS) with the added advantage that the mother can be awake for the birth of her child. RA delivered either by a spinal or top-up epidural technique has significant failure rates leading to conversion to a GA before surgery or during the surgery. This audit attempts to determine the incidences of GA procedures performed on labour ward, particularly CS, and how safe they are for the mother.  
All procedures requiring a GA on labour ward at Queen Charlotte’s and Chelsea hospital (Du Crane Road, London, UK), a specialist high risk maternity hospital, were audited over a 2 year period (1st December 2015 to 1st December 2017) using a proforma completed by the anaesthetic staff retrospectively. Time/ date; grade of most senior obstetrician/anaesthetist present; indication for the procedure; whether RA had been attempted; whether it was a primary GA or a RA to GA conversion; reason for GA conversion; whether there were any critical incidences (CI) were collected for each GA procedure.  
110 GA procedures were performed during this time frame. 86% (n=95) were CS.  Mean incidence of GA elective CS was 2% per month and 5% per month for all emergency CS (category 1/2). 54% (n=60) of procedures were performed out of hours (0800-1700). 40% (n=44) of cases had both consultant anaesthetist and obstetrician presence. 58% (n=64) were primary GA with the rest being RA to GA conversions. Most common reason for conversion was intra-operative pain (57%, n=26). CI occurred in 21% (n=22) of cases, with a large majority occurring during category 1 CS, 71% (n=17) of these cases had consultant anaesthetist present. There were 2 cases of stillbirths and no maternal deaths.
41% (n=45) category 1 CS was performed with 67% (n=30) being primary GA. 90% (n = 26) of primary RA category 1 CS achieved <30 minutes DDI compared to 57% (n =8) for RA conversions. 
Rates of RA to GA conversion as set by the Royal College of Anaesthetists (RCOA) were met and is reassuring of best practice carried out at QCH. CI during these GA procedures performed were far less common in elective CS performed at QCH and had at least one consultant anaesthetist present in the majority of cases. Intraoperative pain requiring GA conversion will need  further investigating to highlight any areas of practice can improve on to lower the number.  


07 / Incidence and safety of general anaesthetics on a high-risk labour ward.