The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England
Author(s) Bhatia K.; Columb M.; Bewlay A.; Eccles J.; Hulgur M. et al.
Source Anaesthesia; 2020
Publication Date 2020
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.Copyright © 2020 Association of Anaesthetists
Author(s) Wilson A.; Lie J.
Source Anaesthesia; Jan 2020; vol. 75 ; p. 66
Following the recommendations of the Francis report, it has been NHS policy that all hospital patients have a named consultant responsible for their care to ensure patient safety. Many theatre lists are run by non-autonomous SAS grades (NASG) who, although they are the lead anaesthetist for their list, have a designed consultant supervisor .
At East Lancashire Hospitals NHS Trust (ELHT), there is a designated duty anaesthetist at both Royal Blackburn Teaching Hospital (RBTH) and Burnley General Teaching Hospital (BGTH).
Methods The audit was conducted as per the Cappuccini test guidance produced by the Royal College of Anaesthetists . Twenty elective lists conducted by NASG over 2 weeks were identified at ELHT. The NASG was asked who is supervising you and how would you get hold of them if you needed them now? I then checked that I was able to contact the consultant myself and then asked the consultant the following four questions: which lists are you currently supervising, in which surgical specialty are they working currently, do you know of any issues that the NASG are concerned about and if they required your help would be able to attend?
Results The NASG knew 19/20 of the names of the duty anaesthetists and all of them knew how to get in contact with the consultant if required, which was by a designated deck phone. I was able to get in contact with all the duty anaesthetists. The duty anaesthetist was aware of 15/20 lists and knew the specialities for 14/ 15 of the lists they were aware of. There were no issues reported and all duty anaesthetists said they were able to attend if required for the lists they were aware of (15/15); however, for two of the lists (same supervisor/session), the duty anaesthetist was carrying the registrar bleep due to sickness so would have been less available than usual. Discussion The results show that the NASG knew who the duty anaesthetist was and how to contact them. This is most likely due to the fact that there is a designated duty anaesthetist at both RBTH and BGTH, who is not attached to a specific theatre list, but has the responsibility of supervising all theatres including the NASG and giving assistance when required. The knowledge of the duty anaesthetist of the lists they were supervising was lower, RBTH and BGTH are large departments with 11 and 14 theatres, respectively, which likely factors into this score. All duty anaesthetists said they would be able to attend if required with the one example of slight difficulty due to carrying the registrar's bleep due to sickness.
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