191 posters, 5 topics, 20 sessions, 393 authors, 116 institutions
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Obstetric Anaesthesia Annual Scientific Meeting 2023
18 - 19 May, 2023 | EICC Edinburgh
5757126
The journey from thiopentone to propofol for caesarean birth -- experiences from a tertiary unit
Poster Presenter
Authors
Part of Topic
Service Evaluation
Introduction
•The Royal College of Anaesthetists (RCoA) has set best practice standards for the rate of general anaesthesia (GA) use for caesarean delivery, with suggested targets of:
•Category 1: < 50%
•Category 2-3: < 15%
•Category 4: < 5%
•Historically, Thiopentone and Suxamethonium are considered as the induction agents of choice for caesarean delivery in the United Kingdom (UK).
•
•Multiple publications now recommend using Propofol over Thiopentone on the basis of greater drug familiarity, occasional supply issues of Thiopentone and reduced incidence of syringe swap medication errors.
Method
•After obtaining audit committee approval, records of all patients having caesarean delivery at St. Mary’s Hospital, Manchester from January 1st 2021 to August 31st 2022 under general anaesthesia were reviewed.
•
•The general anaesthesia rates for various categories of caesarean delivery were calculated to determine whether our unit met RCoA recommended standards. The data was compared with findings of a similar audit performed between April 2017 and March 2018.
•
•The anaesthesia induction techniques were reviewed along with neonatal outcomes.
Results
During the study period, 5066 caesarean deliveries were recorded with 6.5% performed under a general anaesthetic. Details of the anaesthetic technique, along with the neonatal outcomes and how our findings compared with the 2017-2018 audit are highlighted in Table 1 and Fig-1 & 2.
Discussion
•Our unit continues to meet best practice standards set by the RCoA for general anaesthetic use across different categories of caesarean delivery.
•
•There has been a marked reduction in general anaesthesia use for category – 1 caesarean delivery.
•
•The combinations of drugs being used for induction of anaesthesia has changed significantly since the 2017/18 study period.
•Propofol and Rocuronium is the most popular combination, observed in 93% of cases.
•
•Opioid use pre-delivery has increased, with Alfentanil being administered most frequently pre-delivery.
•
•Neonatal outcome data demonstrates lower Apgar scores and Umbilical artery/vein pH in the 2021/22 study period.
•
•The higher incidence of observed anaphylaxis with Suxamethonium and the increasing availability of Sugammadex has led to a shift towards use of Rocuronium as the neuromuscular blocking agent of choice for general anaesthesia in caesarean deliveries.
•
•Good intubating conditions can be obtained in a timely fashion for a more prolonged period of time with Rocuronium and it can also be rapidly reversed if a difficult airway or a failed intubation scenario is encountered.
•The combined impact of the use of Propfol, Rocuronium and pre-delivery opioids on this neonatal outcome data requires further research and ideally matched maternal data for the different categories of caesarean delivery to draw more meaningful conclusions.
References
1.Royal College of Anaesthetists. Section 7: Obstetric Practice, Raising the Standards: RCoA quality improvement compendium. 4th edition, September 2020. https://rcoa.ac.uk/sites/default/files/documents/2020-08/21075%20RCoA%20Audit%20Recipe%20Book_Combined_Final_25.08.2020_0.pdf .
2.Odor PM, Bampoe S, Moonesinghe SR et al. General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study. Anaesthesia. 2020;76:460-71. https://doi.org/10.1111/anae.15250