PLD.36 An investigation into the increased use of general anaesthesia (GA) for operative deliveries

Abstract

Background In Tayside the number of women receiving GA for operative delivery is increasing. For pregnant women GA is associated with difficulties in airway management, aspiration and increased maternal mortality. Aims To determine the rate of GA for operative delivery, the indications for GA and complications associated with GA. Methods All women who delivered in NHS Tayside in 2013 were included. Information for women who had GA for operative delivery was obtained from the maternity notes and the local maternity database (Torex Protos Evolution, v3.5.19). Results 81/4316(1.9%) women had GA for delivery. 80/81(98.8%) had caesarean section (CS). The most common indication for GA was category 1 CS (45/81, 55.5%). 129 women had category 1 CS and 45/129(34.9%) had GA. 18/81(22.2%) had GA for unsuccessful regional anaesthesia. 3 women converted to GA because of intra-operative pain. 8/18(44.4%) who had unsuccessful regional anaesthesia had BMI >25 kg/m2 and only 1/18(5.6%) had BMI >40 kg/m2. 5/81(6.2%) requested GA for delivery. 2/81(2.5%) had complicated intubations and 3/81(3.7%) developed pneumonia. Conclusions It is widely accepted that GA is used for operative delivery where there is insufficient time for regional anaesthesia or in situations where regional techniques are contraindicated. In our population the majority of women who require Category 1 CS have this procedure with regional anaesthesia. There were a range of indications for the use of general anaesthesia, including patient preference. Although the complication rates in our population are low, GA is a high-risk intervention and should only be used for operative delivery when it is clearly indicated.