General anaesthesia for operative obstetrics

Abstract

Caesarean birth remains the most performed obstetric surgical procedure globally. In the UK, though most caesarean births are performed under neuraxial anaesthesia, general anaesthesia (GA) remains the quickest option for emergency caesarean birth, and may be more appropriate for complex cases, such as those involving placenta accreta spectrum disorder. Propofol and rocuronium use for GA for caesarean birth in the UK is increasing. Whilst the evidence for routine use of videolaryngoscopy in the obstetric population is currently lacking, there is a growing interest in this, as well as the use of apnoeic oxygenation, total intravenous anaesthesia and processed electroencephalography for obstetric GA. Avoidable GA for caesarean birth may be associated with significant maternal morbidity. Training and clinical practices should continue to emphasize the identification and management of risks including aspiration, accidental awareness, and difficult or failed intubation. Carrying out simulation drills for anaesthetic emergencies, including failed intubation in patients requiring emergency caesarean birth, offers valuable insight into human factors for the multidisciplinary team, and opportunity for structured debriefing and constructive feedback.