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The Impact of NAP5 on Obstetric Anaesthesia: an OAA Approved UK Survey
Abstract Number: T-12
Abstract Type: Original Research
The findings of the 5th National Audit Project (NAP5) conducted in the UK by the Royal College of Anaesthetists (RCOA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) have recently been released.(1) This national project is the largest prospective study investigating accidental awareness under general anesthesia (AAGA). Obstetrics was the most markedly over-represented surgical specialty, with the incidence of AAGA found to be 1:670 when general anesthesia was used for cesarean delivery. The aim of this survey was to evaluate the impact of NAP5 findings on obstetric general anesthesia practice in the UK.
Following Obstetric Anaesthetists' Association (OAA) audit committee approval, all 1372 UK consultant members were invited to complete an electronic survey using the OAA online submission system. Questions explored obstetric general anesthesia practice before and after the release of NAP5, and examined if recommendations were being implemented into routine clinical practice. Results were analyzed using difference in proportions with 95% confidence intervals and exact two-sided mid-P values; P<0.05 was regarded as statistically significant.
There were 540 responses (39.4% response rate). Key findings are summarized in the table. Following the NAP5 findings, 15% of respondents would increase the dose of induction agent used in obstetrics to reduce risk of AAGA. Nineteen percent would now increase the minimum alveolar concentration (MAC) of volatile used during cesarean delivery, with most of these respondents (63%) aiming to achieve this between induction of anesthesia and delivery. Approximately two- thirds (65%) of respondents now implement a strategy to reduce the risk of latent drug errors, the most common being to keep induction agents and antibiotics in separate locations.
Our results show that obstetric general anesthesia practice is evolving in the UK following the release of NAP5. Traditional techniques of general anesthesia are being superseded by those previously considered controversial, most notably the use of propofol and opioids at induction. It is encouraging that recommendations from NAP5 are being implemented, however, the clinical impact for both mother and foetus has yet to be determined.
1) NAP5: Accidental Awareness during General Anaesthesia in the UK and Ireland. http://www.nationalauditprojects.org.uk/NAP5_home.