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Anesthesia for caesarean delivery and the failure rate of primary neuraxial anesthesia: a 6 month analysis within a 16,000 delivery per year tertiary referral centre in Qatar
Abstract Number: F2A-4
Abstract Type: Original Research
INTRODUCTION:We reviewed the cesarean delivery (CD) anesthesia techniques and the incidence of failed neuraxial anesthesia (NA) for 6 mths in the Qatar Women’s Hospital delivering over 16,000 women / yr. The UK Royal College of Anaesthetists (RCOA) audit standards, state NA for category 4 CD should be used in over 95% of cases and over 85% for category 1-3. Also, NA to general anesthesia (GA) conversion rates should be under 1% for category 4 and under 5% for category 1-3 CD. We conducted this review to benchmark our high volume delivery unit in terms of NA data for CD against the RCOA standards.
METHODS: We collected data from 1 July to 31 December 2017 using the Cerner electronic database and cross referenced the written operating theatre record book for missing data. A review of each patients perioperative record with failed NA was carried out to check the alternative method of anesthesia.
RESULTS: 2,653 CDs were performed during the 6 mth period, approximately 450 CD/mth. NA was used in 2,531 (95.4%) and GA in 122 (4.6%) of cases. Of 2,653 cases, 1,070 cases were elective and 1,583 cases were emergency CDs. 1,032 (96.4%) elective cases were performed under NA compared to 1,499 (94.6%) emergencies. There were 40 (1.6%) cases of failed primary NA. 35 patients eventually received GA, 3 CSE (combined spinal epidural) and 2 spinal anesthesia. Out of 40 failed primary NA techniques, 28 were emergency and 12 were elective cases (Table). The GA rate was 5.3% and 3.5% for emergency and elective cases respectively.
DISCUSSION: 95.4% of cases of CD were carried out under NA with a low GA rate of 4.6%, meeting the RCOA standard. 5.3% of emergency and 3.5% of elective CDs were performed under GA when compared to the RCOA standard of less than 15% for emergency and 5% for elective CD. The rate of GA conversion for failed primary NA in elective CD was 0.9% and 1.6% for elective and emergencies respectively, comparable to the RCOA standard of 1% and 5%. Our compliance with these standards may be due to multiple factors including a high surveillance of labor epidurals to reduce the incidence of failed epidural catheters. The continuous 24 hour presence of 2 experienced obstetric anesthesia consultants and 2 sub-consultants allow complete coverage of all areas of clinical activity. As our deliveries increase in Qatar, we aim to re-audit the data in the near future.