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Obstetric Anaesthesia Annual Scientific Meeting 2025
May 15 - 16, 2025 | ICC, 2 Lanyon Place, Belfast BT1 3WH
6780812
A Survey of practice regarding Wake or Proceed discussions in Category one Caesarean Sections
Poster Presenter
Authors
Affiliations
Part of Topic
Surveys
A survey of practice regarding Wake or Proceed discussions in Category one Caesarean Sections across multiple NHS Trusts
Christopher Ng, ThaamharahMahendrayogam, Whittington Hospital NHS Trust
Introduction
•The incidence of difficult airway in obstetrics is higher than in the general population at 1 in 49[1]. The 2015 Obstetric Anaesthetists’ Association (OAA) and Difficult Airway Society (DAS) guideline [2] tries to offer a systematic approach to difficult obstetric intubations.
•In the event of a failed intubation post induction, the team must make a decision whether it is appropriate to proceed or to wake the patient up.
•Though it is rarely necessary to wake the patient, guidelines recommend a discussion on its appropriateness in the event of a failed intubation.
•When looking to implement this guidance into our trust, we sought to find out whether or not other trusts did so and how they approached this sensitive topic.
Method
•We conducted a online poll of OAA leads across the UK for obstetric anaesthesia surveying whether “Wake or Proceed” was routinely discussed before a category one CS under general anaesthesia (GA).
Result
•Clinical leads from 48 trusts responded to the survey. 6 (12.5%) stated yes. 2 (4.2%) stated no, but they were planning to. 40 (83.3%) stated no. See figure 1.
•Respondents consented to publish anonymised data.
Discussion:
What is the problem?
•The majority of trusts do not routinely discuss wake versus proceed before a category one CS
•Is this because trusts are unaware, or they disagree with the guidance, or simply have not found a way to incorporate it?
When should this discussion take place?
•It is potentially too late to have this discussion in the midst of a failed intubation or the moments leading up to a category 1 CS.
•OAA advises a discussion both prior to induction and then re-reviewed if failed intubation occurs
Why does there need to be an discussion?
•Wake versus Proceed is a complex topic. Table 1, provided by OAA/DAS aims to assist with decision making.
•As this is time critical, prior awareness of the table is advisable.
Who should be involved in this decision?
•This requires input from the multidisciplinary team, including anaesthetist and obstetrician
•A paternalistic approach is usually adopted by anaesthetists to act in what they deem to be the mother’s best interests.
How have we tackled Wake versus Proceed at our trust?
•At our trust, it was felt to be difficult and potentially inappropriate to include wake or proceed in the presence of an awake patient and therefore was not included in our category 1 checklist. However, we have re-introduced the topic as part of a category 1 CS under GA scenario in our Practical Obstetric Multi-Professional Training (PROMPT) course.
•This aims to educate the multidisciplinary labour ward team about the challenges of wake versus proceed and the importance of its early consideration. Ideally this should be done in a calm and sensitive manner when patients are present.
•Staff are also reminded to do prompt airway assessments for new labour ward admissions to identify patients with potentially difficult airways early and plan with the MDT accordingly.