Incidence and risk factors for maternal hypoxaemia during induction of general anaesthesia for non-elective Caesarean section: a prospective multicentre study

Abstract

y Authors' affiliations 1 and 2 are current affiliations, affiliation 5 is where the work was carried out. z The members of the CAESAR working group are listed in acknowledgement section.

Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting

“…Due to these all factors, difficult and failed intubation after general anesthesia are found to be major contributing factors for the anesthesia related maternal complications [ 12 ]. As it is shown in multicenter observational study done on 895 women, the incidence of hypoxemia was 19% and it was significantly associated with difficult and failed intubation during general anesthesia for emergency cesarean section [ 13 ]∗∗. Poor airway assessment contributed to poor airway outcomes because of omission, incomplete assessment or a failure to alter the airway management technique in response to findings at assessment.…”

Choice of hypnotic drug for obstetric and non-obstetric general anaesthesia. Comment on Br J Anaesth 2020; 125: e81–7

“…In particular, administration of neuromuscular blocking agents provides the best intubating conditions, regardless of the co-administered hypnotic drug. 2 In a prospective multicentre study assessing the risk factors for maternal hypoxaemia, which included as secondary outcomes risk factors for difficult intubation during induction of general anaesthesia for non-elective Caesarean section, Bonnet and colleagues 3 reported that use of propofol at induction of anaesthesia was protective for difficult or failed tracheal intubation in comparison with other hypnotic drugs. In other words, their results suggest that intubating conditions are better when co-administering propofol with succinylcholine than when co-administering thiopental with succinylcholine.…”

“…Although thiopental was used in almost three quarters of the cases in the study by Bonnet and colleagues, 3 its use in obstetric anaesthesia has been decreasing for 20 yr in the UK, 7 creating a vicious cycle whereby decreased use leads to decreased experience of trainees and junior anaesthetists with thiopental, which in turn results in decreased use. Previous reports of thiopental over-or under-dosage and of more frequent accidental awareness when using thiopental compared with other drugs illustrate the unfamiliarity of anaesthetists with this drug, begging the question of whether we should teach our trainees better or give up the use of thiopental in anaesthesia.…”

“… 4 In particular, a crucial point to consider is the definition of what a ‘difficult intubation’ is. Number of intubation attempts was used to define difficult intubation in the study by Bonnet and colleagues, 3 a criterion that is dependent in part on the skill of the operator and the anatomy of the patient. The use of a standardised qualitative scoring system, such as that proposed by the consensus conference of good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents, would have been more appropriate to assess intubating conditions as the criteria used in this scale are independent of the morphological characteristics of patients and allow reliable comparison of intubating conditions provided by various general anaesthesia induction regimens.…”

The power of marginal gains in obstetric anaesthesia

“…These risk factors are echoed in a recently published multicentre obstetric study from France, although the incidence of maternal hypoxaemia in the French study was lower at 9.4% (CI 7.6 to 11.3). 6 Prevention of peri-induction hypoxaemia in obstetric patients should be a priority and starts with good planning and preparation. We cannot change patient characteristics such as BMI, but we can ensure that our approach to anaesthetic care provides a mantle of safety to everyone for whom we care.…”