@article{fdb178c3c74a472bbfb683f608b9bf80,
title = "General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study*",
abstract = "There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients{\textquoteright} (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16–22) and failed intubation in 1 in 312 (95%CI 1 in 169–667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).",
keywords = "airway management, caesarean section, general anaesthesia, obstetrics",
author = "{Pan-London Perioperative Audit and Research Network (PLAN), for the DREAMY Investigators Group} and Odor, {P. M.} and S. Bampoe and Moonesinghe, {S. R.} and J. Andrade and Pandit, {J. J.} and Lucas, {D. N.} and A. A{\textquoteright}Court and D. Abdel-Gadir and A. Abdu and C. Abisogun and Z. Aboud and J. Abrams and A. Ackerman and C. Adamson and R. Addison and A. Adeyeye and R. Adler and M. Aduse-Poku and S. Adyanthaya and N. Ahmad and D. Ahmed and A. Ahmed and B. Akindele and O. Akindele and S. Akrimi and S. Al-Rawi and Y. Ali and J. Allam and A. Allana and K. Allen and O. Allen and N. Amaradasa and L. Amarasekara and F. Amoakwa-adu and P. Anandageetha and S. Anandakrishnan and R. Anandanadesan and M. Anderson and S. Apps and A. Aquilina and G. Arbane and A. Arch and S. Armstrong and R. Arya and G. Ashiru and K. Ashpole and C. Atkinson and F. Atkinson and E. Auer and B. Avery and M. Babio-Galan and H. Bader and G. Badham and S. Bagchi and S. Bailey and Y. Baird and C. Balaka and M. Baldwin and P. Balfour and S. Bali and S. Banks and P. Barclay and L. Barnes and T. Barnes and N. Barot and S. Barrett and V. Barrett and K. Barrett and L. Bates and K. Batte and B. Baytug and M. Behravesh and S. Bell and R. Benloch and R. Bentley and J. Berg and C. Berwick and R. Berwick and R. Bhadange and S. Bhattacharyya and E. Bielskute and S. Birch and S. Bird and Ruth Bird and William Birts and Becky Black and Tatyana Blagova and Holly Blake and Oliver Blightman and Susara Blunden and R. Bolton and C. Borkett-Jones and J. Boselli and M. Bowen and R. Bowen and J. Bowyer and H. Boyle and Z. Brar and J. Bray and S. Brayshaw and C. Bressington and A. Brewer and N. Brice and L. Bridge and J. Briscoe and S. Brocklesby and H. Brown and S. Brown and D. Brunnen and K. Burijintichenna and S. Burnard and A. Burtt and V. Buswell and H. Bykar and M. Cairney and C. Calvert and L. Camarasa and N. Campbell and F. Campbell-Jones and J. Cantliffe and W. Carrol and J. Carvalho and C. Cashell and S. Cassie and K. Cassim and M. Chandler and R. Chapman and R. Charles and P. Chen and D. Cheyne and K. Chima and F. Chin and R. Chirvasuta and {Shao Chong}, M. and S. Choudhury and P. Chowdhury and T. Christmas and S. Chughwani and S. Ciechanowicz and E. Clarey and R. Coe and J. Cohen and N. Coker and K. Collins and L. Collis and J. Comar and M. Conroy and K. Constantin and J. Corfe and E. Coulborn and V. Cowie and R. Crone and J. Cronin and J. Crooks and N. Crowther and E. Crowther and C. Cruz and A. Curtis and S. Curtis and A. Dabrowicz and N. Daines and V. Dalal and P. Dannatt and D. Das and J. Dash and K. Davidson and S. Davies and Y. Davis and J. Dawson and J. Dean and C. Dean and J. Denman and N. Desai and P. Dewan and S. Dimont and C. Donovan and M. Doraiswami and K. Doughty and J. Douglass and M. Dower and S. Downing and W. Duberry and E. Duckham and L. Dudgeon and S. Dukes and L. Dunn and V. Duraiswamy and Dwyer, {A. O{\textquoteright}} and K. Dyer and S. Eapen and M. Earl and S. Eason and K. Edwards and Z. Edwards and O. Egole and J. Ekpa and O. El-Amin and K. El-Boghdadly and O. Elbasir and D. Monks",
note = "Funding Information: Registered at ClinicalTrials.gov Identifier (NCT03100396). We wish to thank the allied trainee research networks that helped support this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri‐operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). This work was supported by an Obstetric Anaesthetists{\textquoteright} Association research grant. JP was the clinical lead for the 5th National Audit Project (NAP5). NL chairs the Obstetric Anaesthetists{\textquoteright} Association Education subcommittee and is an Editor for the . No other external funding or competing interests declared. International Journal of Obstetric Anesthesia Publisher Copyright: {\textcopyright} 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",
year = "2021",
month = apr,
doi = "10.1111/anae.15250",
language = "English",
volume = "76",
pages = "460--471",
journal = "Anaesthesia",
issn = "0003-2409",
number = "4",
}