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Armstrong RA, Cook TM, Kunst G, Kane AD, Kursumovic E, Lucas DN, Nickols G, Soar J, Mouton R. Cardiac arrest in vascular surgical patients receiving anaesthetic care: an analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists. Anaesthesia 2024; 79:506-513. [PMID: 38173364 DOI: 10.1111/anae.16208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK. We report the results of the vascular surgery cohort from the 12-month case registry, from 16 June 2021 to 15 June 2022. Anaesthesia for vascular surgery accounted for 2% of UK anaesthetic caseload and included 69 (8%) reported peri-operative cardiac arrests, giving an estimated incidence of 1 in 670 vascular anaesthetics (95%CI 1 in 520-830). The high-risk nature of the vascular population is reflected by the proportion of patients who were ASA physical status 4 (30, 43%) or 5 (19, 28%); the age of patients (80% aged > 65 y); and that most cardiac arrests (57, 83%) occurred during non-elective surgery. The most common vascular surgical procedures among patients who had a cardiac arrest were: aortic surgery (38, 55%); lower-limb revascularisation (13, 19%); and lower-limb amputation (8, 12%). Among patients having vascular surgery and who had a cardiac arrest, 28 (41%) presented with a ruptured abdominal aortic aneurysm. There were 48 (70%) patients who had died at the time of reporting to NAP7 and 11 (16%) were still in hospital, signifying poorer outcomes compared with the non-vascular surgical cohort. The most common cause of cardiac arrest was major haemorrhage (39, 57%), but multiple other causes reflected the critical illness of the patients and the complexity of surgery. This is the first analysis of the incidence, management and outcomes of peri-operative cardiac arrest during vascular anaesthesia in the UK.
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Affiliation(s)
- R A Armstrong
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Severn Deanery, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - G Kunst
- Department of Anaesthesia, Kings College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - A D Kane
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - E Kursumovic
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
- University of Bristol, Bristol, UK
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Lucas DN, Kursumovic E, Cook TM, Kane AD, Armstrong RA, Plaat F, Soar J. Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:514-523. [PMID: 38214067 DOI: 10.1111/anae.16204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/13/2024]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest. Additional inclusion criteria for obstetric anaesthesia were: cardiac arrest associated with neuraxial block performed by an anaesthetist outside the operating theatre (labour epidural analgesia); and cardiac arrest associated with remifentanil patient-controlled analgesia. There were 28 cases of cardiac arrest in obstetric patients, representing 3% of all cardiac arrests reported to NAP7, giving an incidence of 7.9 per 100,000 (95%CI 5.4-11.4 per 100,000). Obstetric patients were approximately four times less likely to have a cardiac arrest during anaesthesia care than patients having non-obstetric surgery. The single leading cause of peri-operative cardiac arrest in obstetric patients was haemorrhage, with underestimated severity and inadequate early resuscitation being contributory factors. When taken together, anaesthetic causes, high neuraxial block and bradyarrhythmia associated with spinal anaesthesia were the leading causes overall. Two patients had a cardiac arrest related to labour neuraxial analgesia. There were no cardiac arrests related to failed airway management or remifentanil patient-controlled analgesia.
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Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - E Kursumovic
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - A D Kane
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Cook TM, Lucas DN, Soar J. Judgements of quality of care in NAP7: a clarification from the authors. Anaesthesia 2024. [PMID: 38516759 DOI: 10.1111/anae.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Tim M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, London, UK
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Kane AD, Cook TM, Armstrong RA, Kursumovic E, Davies MT, Agarwal S, Nolan JP, Smith JH, Moppett IK, Oglesby FC, Cortes L, Taylor C, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Varney L, Soar J. The incidence of potentially serious complications during non-obstetric anaesthetic practice in the United Kingdom: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2024; 79:43-53. [PMID: 37944508 DOI: 10.1111/anae.16155] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 11/12/2023]
Abstract
Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, we studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all cases undertaken over 4 days at their site through an online survey. Of 416 hospital sites invited to participate, 352 (85%) completed the survey. Among 24,172 cases, 1922 discrete potentially serious complications were reported during 1337 (6%) cases. Obstetric cases had a high reported major haemorrhage rate and were excluded from further analysis. Of 20,996 non-obstetric cases, 1705 complications were reported during 1150 (5%) cases. Circulatory events accounted for most complications (616, 36%), followed by airway (418, 25%), metabolic (264, 15%), breathing (259, 15%), and neurological (41, 2%) events. A single complication was reported in 851 (4%) cases, two complications in 166 (1%) cases and three or more complications in 133 (1%) cases. In non-obstetric elective surgery, all complications were 'uncommon' (10-100 per 10,000 cases). Emergency (urgent and immediate priority) surgery accounted for 3454 (16%) of non-obstetric cases but 714 (42%) of complications with severe hypotension, major haemorrhage, severe arrhythmias, septic shock, significant acidosis and electrolyte disturbances all being 'common' (100-1000 per 10,000 cases). Based on univariate analysis, complications were associated with: younger age; higher ASA physical status; male sex; increased frailty; urgency and extent of surgery; day of the week; and time of day. These data represent the rates of potentially serious complications during routine anaesthesia care and may be valuable for risk assessment and patient consent.
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Armstrong RA, Soar J, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Cook TM. Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:18-30. [PMID: 37972476 DOI: 10.1111/anae.16156] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. Here we report the results of the 12-month registry, from 16 June 2021 to 15 June 2022, focusing on epidemiology and clinical features. We reviewed 881 cases of peri-operative cardiac arrest, giving an incidence of 3 in 10,000 anaesthetics (95%CI 3.0-3.5 per 10,000). Incidence varied with patient and surgical factors. Compared with denominator survey activity, patients with cardiac arrest: included more males (56% vs. 42%); were older (median (IQR) age 60.5 (40.5-80.5) vs. 50.5 (30.5-70.5) y), although the age distribution was bimodal, with infants and patients aged > 66 y overrepresented; and were notably more comorbid (73% ASA physical status 3-5 vs. 27% ASA physical status 1-2). The surgical case-mix included more weekend (14% vs. 11%), out-of-hours (19% vs. 10%), non-elective (65% vs. 30%) and major/complex cases (60% vs. 28%). Cardiac arrest was most prevalent in orthopaedic trauma (12%), lower gastrointestinal surgery (10%), cardiac surgery (9%), vascular surgery (8%) and interventional cardiology (6%). Specialities with the highest proportion of cases relative to denominator activity were: cardiac surgery (9% vs. 1%); cardiology (8% vs. 1%); and vascular surgery (8% vs. 2%). The most common causes of cardiac arrest were: major haemorrhage (17%); bradyarrhythmia (9%); and cardiac ischaemia (7%). Patient factors were judged a key cause of cardiac arrest in 82% of cases, anaesthesia in 40% and surgery in 35%.
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Armstrong RA, Cook TM, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Soar J. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:31-42. [PMID: 37972480 DOI: 10.1111/anae.16157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.
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Kursumovic E, Soar J, Nolan JP, Plaat F, Kane AD, Armstrong RA, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Patel B, Pappachan VJ, Scholefield BR, Smith JH, Varney L, Cook TM. Organisation of UK hospitals and anaesthetic departments in the treatment of peri-operative cardiac arrest: an analysis from the 7th National Audit Project (NAP7) local co-ordinator baseline survey. Anaesthesia 2023; 78:1442-1452. [PMID: 37920932 DOI: 10.1111/anae.16153] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 11/04/2023]
Abstract
We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri-operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on-site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri-operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal.
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Kursumovic E, Cook TM, Lucas DN, Davies MT, Martin S, Kane AD, Armstrong RA, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Beecham E, Cordingley J, Dorey J, Finney SJ, Kunst G, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Wain EC, Soar J. The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest. Anaesthesia 2023; 78:1453-1464. [PMID: 37920919 DOI: 10.1111/anae.16154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative.
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Bamber JH, Lucas DN. Recent studies on racial disparities in obstetric care in the USA: a reply. Anaesthesia 2023. [PMID: 37145955 DOI: 10.1111/anae.16037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Affiliation(s)
- J H Bamber
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, London, UK
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Kane AD, Lucas DN, Soar J, Plaat F, Cook TM. NAP7 and obstetric activity: important and measured. Anaesthesia 2023. [PMID: 37020328 DOI: 10.1111/anae.16022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Affiliation(s)
- A D Kane
- James Cook University Hospital, Middlesbrough, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, London, UK
| | - J Soar
- Southmead Hospital, Bristol, UK
| | - F Plaat
- Queen Charlotte's and Chelsea Hospital, London, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Bamber JH, Goldacre R, Lucas DN, Quasim S, Knight M. A national cohort study to investigate the association between ethnicity and the provision of care in obstetric anaesthesia in England between 2011 and 2021. Anaesthesia 2023. [PMID: 36893444 DOI: 10.1111/anae.15987] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
There is evidence that ethnic inequalities exist in maternity care in the UK, but those specifically in relation to UK obstetric anaesthetic care have not been investigated before. Using routine national maternity data for England (Hospital Episode Statistics Admitted Patient Care) collected between March 2011 and February 2021, we investigated ethnic differences in obstetric anaesthetic care. Anaesthetic care was identified using OPCS classification of interventions and procedures codes. Ethnic groups were coded according to the hospital episode statistics classifications. Multivariable negative binominal regression was used to model the relationship between ethnicity and obstetric anaesthesia (general and neuraxial anaesthesia) by calculating adjusted incidence ratios for the following: differences in maternal age; geographical residence; deprivation; admission year; number of previous deliveries; and comorbidities. Women giving birth vaginally and by caesarean section were considered separately. For women undergoing elective caesarean births, after adjustment for available confounders, general anaesthesia was 58% more common in Caribbean (black or black British) women (adjusted incidence ratio [95%CI] 1.58 [1.26-1.97]) and 35% more common in African (black or black British) women (1.35 [1.19-1.52]). For women who had emergency caesarean births, general anaesthesia was 10% more common in Caribbean (black or black British) women (1.10 [1.00-1.21]) than British (white) women. For women giving birth vaginally (excluding assisted vaginal births), Bangladeshi (Asian or Asian British), Pakistani (Asian or Asian British) and Caribbean (black or black British) women were, respectively, 24% (0.76 [0.74-0.78]), 15% (0.85 [0.84-0.87]) and 8% (0.92 [0.89-0.94]) less likely than British (white) women to receive neuraxial anaesthesia. This observational study cannot determine the causes for these disparities, which may include unaccounted confounders. Our findings merit further research to investigate potentially remediable factors such as inequality of access to appropriate obstetric anaesthetic care.
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Affiliation(s)
- J H Bamber
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, University of Oxford, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, Harrow, UK
| | - S Quasim
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - R Wong
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - R Kearsley
- Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland
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13
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Kane AD, Soar J, Armstrong RA, Kursumovic E, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Cook TM. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2023; 78:701-711. [PMID: 36857758 DOI: 10.1111/anae.15989] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.
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Affiliation(s)
- A D Kane
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - R A Armstrong
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M T Davies
- Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK
| | - F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - L Cortes
- Royal College of Anaesthetists, Red Lion Square, UK
| | - C Taylor
- Royal College of Anaesthetists, Red Lion Square, UK
| | - I K Moppett
- Royal College of Anaesthetists, Red Lion Square, UK.,University of Nottingham, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - J Cordingley
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - J Dorey
- Royal College of Anaesthetists, Red Lion Square, UK
| | - S J Finney
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - G Kunst
- Department of Cardiovascular Anaesthesia, Kings College London, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J P Nolan
- Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - B Patel
- Royal College of Anaesthetists, Red Lion Square, UK
| | - V J Pappachan
- Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - L Varney
- Department of Anaesthesia, University College London Hospitals, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, UK
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14
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Bamber JH, Lucas DN, Russell R. The delivery of obstetric anaesthetic care in UK maternity units: a survey of practice in 2021. Int J Obstet Anesth 2023; 53:103618. [PMID: 36681016 DOI: 10.1016/j.ijoa.2022.103618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anaesthetists are crucial members of the maternity unit team, providing peri-operative analgesia and anaesthesia, and supporting the delivery of medical care to high-risk women. The effective contribution from obstetric anaesthetists to safety in maternity units depends on how anaesthesia services are organised and resourced. There is a lack of information on how obstetric anaesthetic care is resourced in the UK. METHODS The Obstetric Anaesthetists' Association surveyed UK clinical leads for their hospital's obstetric anaesthetic service and examined compliance with national recommendations. RESULTS There were 153 responses by lead obstetric anaesthetists from 184 maternity units in the UK (83%). The number of consultants per 1000 deliveries was 2.2 [1.6-2.7] (median [IQR]). In 20% of units, there was a dedicated on-call rota (on-call only for obstetric anaesthesia), whilst the remainder had a 'combined' on-call rota (on-call for other clinical areas in addition to obstetrics). Multidisciplinary ward rounds were held in 83% of units. Twenty-five (16%) units reported having no regular multidisciplinary ward rounds, of which nine (6%) did not have any multidisciplinary ward rounds. Planned operating lists for elective caesarean sections were provided in 77% of units. CONCLUSIONS In the largest survey of obstetric anaesthesia workload to be reported for any health system, we found significant disparities between obstetric anaesthesia service provision and current national recommendations for areas including consultant staffing, support for elective caesarean section lists, antenatal anaesthetic clinics, and consultant support for service development. Wide national variation in service provision was identified.
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Affiliation(s)
- J H Bamber
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK.
| | - R Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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15
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Cranfield K, Horner D, Vasco M, Victory G, Lucas DN. Current perspectives on maternity critical care. Anaesthesia 2023; 78:758-769. [PMID: 36633911 DOI: 10.1111/anae.15948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
Maternal critical care is a developing area of clinical practice. Looking after a critically ill woman requires a multidisciplinary team that must endeavour to maintain the relative normality of pregnancy. Whilst consideration of the fetus should be taken when making clinical decisions regarding maternal care, unfounded concerns for the fetus can contribute to therapeutic inertia such that potentially life-saving therapies are denied to pregnant women. The management of a critically ill obstetric patient must reflect, as closely as possible, the management of critical illness outside pregnancy. We will discuss some of the current evidence and concepts around this emerging area in obstetrics, including enhanced maternity care, maternal medicine networks and clinical care.
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Affiliation(s)
- K Cranfield
- Department of Critical Care, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - D Horner
- Department of Anaesthesia and Critical Care, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - M Vasco
- Constitution Committee and WFSA, Medellin, Colombia.,Department of Anesthesia, Universidad CES, Medellin, Colombia
| | | | - D N Lucas
- Department of Anaesthesia, London North-West University Healthcare NHS Trust, London, UK
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16
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Kane AD, Armstrong RA, Kursumovic E, Cook TM, Oglesby FC, Cortes L, Moppett IK, Moonesinghe SR, Agarwal S, Bouch DC, Cordingley J, Davies MT, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Samuel K, Scholefield BR, Smith JH, Varney L, Vindrola‐Padros C, Martin S, Wain EC, Kendall SW, Ward S, Drake S, Lourtie J, Taylor C, Soar J. Methods of the 7 th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest. Anaesthesia 2022; 77:1376-1385. [PMID: 36111390 PMCID: PMC9826156 DOI: 10.1111/anae.15856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.
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17
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Bishop DG, Lucas DN. If it isn’t written down, then it didn’t happen: documentation in obstetric anaesthesia. Southern African Journal of Anaesthesia and Analgesia 2022. [DOI: 10.36303/sajaa.2022.28.4.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- DG Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
| | - DN Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust,
United Kingdom
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18
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Affiliation(s)
- J Bamber
- Cambridge University Hospitals NHS Foundation Trust, Cambidge, UK
| | - D N Lucas
- London North West Healthcare NHS Trust, London, UK
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19
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Plaat F, Stanford SER, Lucas DN, Andrade J, Careless J, Russell R, Bishop D, Lo Q, Bogod D. Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach. Anaesthesia 2022; 77:588-597. [PMID: 35325933 PMCID: PMC9311138 DOI: 10.1111/anae.15717] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.
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Affiliation(s)
- F Plaat
- Department of Anaesthesia, Queen Charlottes and Chelsea Hospital, London, UK
| | | | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J Careless
- Associate Specialist, Department of Anaesthesia, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R Russell
- Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Bishop
- Metropolitan Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Q Lo
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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May RL, Clayton MA, Richardson AL, Kinsella SM, Khalil A, Lucas DN. Defining the decision-to-delivery interval at caesarean section: narrative literature review and proposal for standardisation. Anaesthesia 2021; 77:96-104. [PMID: 34494667 DOI: 10.1111/anae.15570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
The decision-to-delivery interval is a widely used term at non-elective caesarean section. While the definition may appear self-evident, there is no universally agreed consensus about when this period begins and ends. We reviewed the literature for original research utilising the terms 'decision-to-delivery', 'decision-to-incision' or 'incision-to-delivery' and examined definitions used for decision, delivery, incision, as well as any additional time intervals that were assessed. Our analysis demonstrated an inconsistent non-standardised approach to defining these intervals, which might have clinical practice and medicolegal ramifications. We propose that the decision-to-delivery interval should be defined as follows: the interval between the time at which the senior obstetrician makes the decision that a caesarean section is required and the time at which the fetus (or first fetus in the case of multiples) is delivered. The decision time should ideally be recorded contemporaneously in the medical notes or partogram.
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Affiliation(s)
- R L May
- Imperial School of Anaesthesia, London, UK
| | | | - A L Richardson
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - S M Kinsella
- Department of Anaesthesia, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
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21
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Lucas DN, Russell R, Bamber JH, Elton CD. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 2021; 76:1426-1427. [PMID: 34143444 DOI: 10.1111/anae.15528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- D N Lucas
- London North West NHS Healthcare, Harrow, UK
| | - R Russell
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J H Bamber
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C D Elton
- University Hospitals of Leicester, Leicester, UK
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22
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Richardson AL, Bhuptani S, Lucas DN. The extension of epidural blockade for emergency caesarean delivery: a survey of UK practice. Int J Obstet Anesth 2021; 46:102977. [PMID: 33893008 DOI: 10.1016/j.ijoa.2021.102977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A L Richardson
- London North West University Healthcare NHS Trust, London, UK.
| | - S Bhuptani
- London North West University Healthcare NHS Trust, London, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, London, UK
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23
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Abstract
Infectious diseases can directly affect women and men differently. During the COVID‐19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in‐person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex‐based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID‐19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk‐benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID‐19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.
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Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West NHS Healthcare, London, UK
| | - J H Bamber
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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24
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Orbach-Zinger S, Jadon A, Lucas DN, Sia AT, Tsen LC, Van de Velde M, Heesen M. Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations. Anaesthesia 2021; 76:1111-1121. [PMID: 33476424 DOI: 10.1111/anae.15390] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/20/2023]
Abstract
If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post-dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post-dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post-dural puncture headache. The level of evidence for these recommendations was low.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anaesthesia, Rabin Medical Centre, Beilinson Hospital, Petach Tikvah, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - A Jadon
- Tata Motors Hospital, Jamshedpur, Jharkhand, India.,Anaesthesia, Pain Relief Service, Department of Anaesthesia and Pain Relief Service, Jata Motors Hospital, Jamshedpur, Jharkhand, India
| | - D N Lucas
- LNWH NHS Trust, Harrow, UK.,Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - A T Sia
- Department of Women's Anaesthesia, KK Women and Children Hospital, Singapore, Anaesthesiology Program, Duke-NUS Graduate Medical School, Singapore
| | - L C Tsen
- Harvard Medical School, Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
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25
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Odor PM, Bampoe S, Lucas DN, Moonesinghe SR, Andrade J, Pandit JJ. Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study. Anaesthesia 2021; 76:759-776. [PMID: 33434945 DOI: 10.1111/anae.15385] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m-2 ); low BMI (<18.5 kg.m-2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.
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Affiliation(s)
- P M Odor
- Centre for Anaesthesia and Peri-operative Medicine, University College London Hospital, London, UK
| | - S Bampoe
- Centre for Anaesthesia and Peri-operative Medicine, University College London Hospital, London, UK
| | - D N Lucas
- Department of Anaesthesia, Northwick Park Hospital, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK.,University of Oxford, Oxford, UK
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26
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Odor PM, Lucas DN. General anaesthetic and airway management practice for obstetric surgery in England: a reply. Anaesthesia 2020; 76:580. [PMID: 33368153 DOI: 10.1111/anae.15352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- P M Odor
- University College London Hospital, London, UK
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27
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Russell R, Lucas DN. The effect of COVID-19 disease on general anaesthesia rates for caesarean section. Anaesthesia 2020; 76 Suppl 3:24. [PMID: 33300126 DOI: 10.1111/anae.15346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 01/24/2023]
Affiliation(s)
- R Russell
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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28
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Duffy J, Cairns AE, Richards-Doran D, van 't Hooft J, Gale C, Brown M, Chappell LC, Grobman WA, Fitzpatrick R, Karumanchi SA, Khalil A, Lucas DN, Magee LA, Mol BW, Stark M, Thangaratinam S, Wilson MJ, von Dadelszen P, Williamson PR, Ziebland S, McManus RJ. A core outcome set for pre-eclampsia research: an international consensus development study. BJOG 2020; 127:1516-1526. [PMID: 32416644 DOI: 10.1111/1471-0528.16319] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To develop a core outcome set for pre-eclampsia. DESIGN Consensus development study. SETTING International. POPULATION Two hundred and eight-one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. METHODS Modified Delphi method and Modified Nominal Group Technique. RESULTS A long-list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre-eclampsia trials with those derived from thematic analysis of 30 in-depth interviews of women with lived experience of pre-eclampsia. Forty-seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small-for-gestational-age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. CONCLUSIONS The core outcome set for pre-eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies. TWEETABLE ABSTRACT 281 healthcare professionals, 41 researchers and 110 women have developed #preeclampsia core outcomes @HOPEoutcomes @jamesmnduffy. [Correction added on 29 June 2020, after first online publication: the order has been corrected.].
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Affiliation(s)
- Jmn Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Institute for Women's Health, University College London, London, UK
| | - A E Cairns
- Institute for Women's Health, University College London, London, UK
| | - D Richards-Doran
- Institute for Women's Health, University College London, London, UK
| | - J van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - M Brown
- Department of Renal Medicine, St George Hospital and University of New South Wales, Kogarah, NSW, Australia
| | - L C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - W A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, Harrow, UK
| | - L A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - M Stark
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
| | - S Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - M J Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - P R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - S Ziebland
- Institute for Women's Health, University College London, London, UK
| | - R J McManus
- Institute for Women's Health, University College London, London, UK
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29
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Affiliation(s)
- L. C. Savic
- Department of Anaesthesia Leeds Teaching Hospitals Trust Leeds UK
| | - D. N. Lucas
- Department of Anaesthesia London North West NHS Healthcare London UK
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30
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Odor PM, Bampoe S, Moonesinghe SR, Andrade J, Pandit JJ, Lucas DN. General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study. Anaesthesia 2020; 76:460-471. [PMID: 32959372 DOI: 10.1111/anae.15250] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).
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Affiliation(s)
- P M Odor
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - S Bampoe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - D N Lucas
- Department of Anaesthesia, Northwick Park Hospital, London, UK
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Bampoe S, Lucas DN, Neall G, Sceales P, Aggarwal R, Caulfield K, Siassakos D, Odor PM. A cross-sectional study of immune seroconversion to SARS-CoV-2 in frontline maternity health professionals. Anaesthesia 2020; 75:1614-1619. [PMID: 32777861 DOI: 10.1111/anae.15229] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
COVID-19, the respiratory disease caused by SARS-CoV-2, is thought to cause a milder illness in pregnancy with a greater proportion of asymptomatic carriers. This has important implications for the risk of patient-to-staff, staff-to-staff and staff-to-patient transmission among health professionals in maternity units. The aim of this study was to investigate the prevalence of previously undiagnosed SARS-CoV-2 infection in health professionals from two tertiary-level maternity units in London, UK, and to determine associations between healthcare workers' characteristics, reported symptoms and serological evidence of prior SARS-CoV-2 infection. In total, 200 anaesthetists, midwives and obstetricians, with no previously confirmed diagnosis of COVID-19, were tested for immune seroconversion using laboratory IgG assays. Comprehensive symptom and medical histories were also collected. Five out of 40 (12.5%; 95%CI 4.2-26.8%) anaesthetists, 7/52 (13.5%; 95%CI 5.6-25.8%) obstetricians and 17/108 (15.7%; 95%CI 9.5-24.0%) midwives were seropositive, with an overall total of 29/200 (14.5%; 95%CI 9.9-20.1%) of maternity healthcare workers testing positive for IgG antibodies against SARS-CoV-2. Of those who had seroconverted, 10/29 (35.5%) were completely asymptomatic. Fever or cough were only present in 6/29 (21%) and 10/29 (35%) respectively. Anosmia was the most common symptom occurring in 15/29 (52%) seropositive participants and was the only symptom that was predictive of positive seroconversion (OR 18; 95%CI 6-55). Of those who were seropositive, 59% had not self-isolated at any point and continued to provide patient care in the hospital setting. This is the largest study of baseline immune seroconversion in maternity healthcare workers conducted to date and reveals that one out of six were seropositive, of whom one out of three were asymptomatic. This has significant implications for the risk of occupational transmission of SARS-CoV-2 for both staff and patients in maternity units. Regular testing of staff, including asymptomatic staff should be considered to reduce transmission risk.
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Affiliation(s)
- S Bampoe
- Centre for Anaesthesia and Peri-operative Medicine, University College London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | | | - G Neall
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P Sceales
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Aggarwal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - K Caulfield
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Siassakos
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, UK
| | - P M Odor
- Centre for Anaesthesia and Peri-operative Medicine, University College London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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Bampoe S, Odor PM, Lucas DN. Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far. Int J Obstet Anesth 2020; 43:1-8. [PMID: 32437912 PMCID: PMC7179500 DOI: 10.1016/j.ijoa.2020.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 is a novel coronavirus causing a global pandemic of a severe respiratory illness known as COVID-19. To date, globally, over 30,000 people have died from this emerging disease. As clinicians and healthcare systems around the world are rapidly adapting to manage patients with COVID-19, limited data are emerging from different patient populations to support best-practice and improve outcomes. In this review, we present a summary of emerging data in the obstetric population and offer obstetric and anaesthetic clinicians around the world a set of evidence-driven, practice-based recommendations for the anaesthetic management of pregnant women with suspected or confirmed COVID-19.
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Affiliation(s)
- S Bampoe
- University College London Hospital NHS Foundation Trust, London, UK.
| | - P M Odor
- University College London Hospital NHS Foundation Trust, London, UK
| | - D N Lucas
- Northwick Park Hospital NHS Trust, London, UK
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Affiliation(s)
- J H Bamber
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D N Lucas
- London North West NHS Healthcare, London, UK
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Affiliation(s)
- B. McGuire
- Department of Anaesthesia Ninewells Hospital Dundee UK
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Middlesex UK
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Yentis SM, Lucas DN, Brigante L, Collis R, Cowley P, Denning S, Fawcett WJ, Gibson A. Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020. Anaesthesia 2020; 75:913-919. [DOI: 10.1111/anae.14993] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital London UK
- Imperial College Working Party co‐Chair and Association of Anaesthetists London UK
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Working Party co‐Chair and Obstetric Anaesthetists’ Association London UK
| | - L. Brigante
- Quality and Standards Advisor Royal College of Midwives London UK
| | - R. Collis
- Department of Anaesthesia University Hospital of Wales Obstetric Anaesthetists’ Association Cardiff UK
| | - P. Cowley
- Department of Radiology National Hospital for Neurology and Neurosurgery London UK
| | - S. Denning
- East Midlands School of Anaesthesia Association of Anaesthetists Training Committee UK
| | - W. J. Fawcett
- Royal Surrey County Hospital Association of Anaesthetists Guildford Surrey UK
| | - A. Gibson
- Department of Surgery Royal National Orthopaedic Hospital British Association of Spinal Surgeons Stanmore Middlesex UK
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Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. In reply. Int J Obstet Anesth 2020; 42:113. [PMID: 31956002 DOI: 10.1016/j.ijoa.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
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Bamber JH, Lucas DN, Plaat F, Allin B, Knight M. The identification of key indicators to drive quality improvement in obstetric anaesthesia: results of the Obstetric Anaesthetists' Association/National Perinatal Epidemiology Unit collaborative Delphi project. Anaesthesia 2019; 75:617-625. [PMID: 31657014 PMCID: PMC7187417 DOI: 10.1111/anae.14861] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2019] [Indexed: 11/30/2022]
Abstract
A three‐stage Delphi survey process was undertaken to identify the quality indicators considered the most relevant to obstetric anaesthesia. The initial quality indicators assessed were derived from national peer‐reviewed publications and were divided into service provision, service quality and clinical outcomes. A range of stakeholders were invited to participate and divided into three panels: obstetric anaesthetists; other maternity care health professionals; and women who had used maternity services. In total, 133 stakeholders registered to participate with 80% completing all three phases of the survey process. Participants ranked indicators for their relative importance using the grading of recommendations assessment, development and evaluation scale. From an initial list of 31 quality indicators, 11 indicators were rated as extremely important by > 90% of participants in at least two panels. These 11 indicators were presented to stakeholders; they were asked to vote for the five indicators they considered most relevant and useful for assessing and benchmarking the quality of obstetric anaesthesia provided. The indicators chosen were: the percentage of women who had an epidural/combined spinal‐epidural for labour analgesia with accidental dural puncture; the presence of guidelines for the referral of patients to an anaesthetist for antenatal review; whether there are dedicated elective caesarean section lists; the availability of point‐of‐care testing for estimation of haemoglobin concentration; and the percentage of epidurals for labour analgesia that provided adequate pain relief within 45 min of the start of epidural insertion. These indicators may be used for quality improvement and national benchmarking to support the implementation of quality standards in obstetric anaesthesia.
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Affiliation(s)
- J H Bamber
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D N Lucas
- Department of Anaesthesia, London North West NHS Healthcare, London, UK
| | - F Plaat
- Department of Anaesthesia, Queen Charlottes and Chelsea Hospital, London, UK
| | - B Allin
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford, UK
| | - M Knight
- Maternal and Child Population Health National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Heesen M, Carvalho B, Carvalho JCA, Duvekot JJ, Dyer RA, Lucas DN, McDonnell N, Orbach‐Zinger S, Kinsella SM. International consensus statement on the use of uterotonic agents during caesarean section. Anaesthesia 2019; 74:1305-1319. [DOI: 10.1111/anae.14757] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 01/21/2023]
Affiliation(s)
- M. Heesen
- Department of Anaesthesia Kantonsspital Baden Switzerland
| | - B. Carvalho
- Department of Anesthesiology Stanford University School of Medicine Stanford CAUSA
| | - J. C. A. Carvalho
- Department of Anaesthesia and Department of Obstetrics and Gynaecology University of Toronto ONCanada
| | - J. J. Duvekot
- Department of Obstetrics and Gynecology Erasmus Medical Centre Rotterdam Rotterdamthe Netherlands
| | - R. A. Dyer
- Department of Anaesthesia and Peri‐operative Medicine University of Cape Town Cape TownSouth Africa
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Harrow UK
| | - N. McDonnell
- Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco WA Australia
| | - S. Orbach‐Zinger
- Department of Anaesthesia Beilinson Hospital, Petach Tikvah, and Sackler Medical School Tel Aviv University Tel Aviv Israel
| | - S. M. Kinsella
- Department of Anaesthesia St Michael's Hospital Bristol UK
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Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch. Int J Obstet Anesth 2019; 38:104-118. [PMID: 30711239 DOI: 10.1016/j.ijoa.2018.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. Despite suffering long-term headaches, neither woman was adequately followed-up after discharge from hospital. Death resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the other. Due to significant variation in the treatment of obstetric post-dural puncture headache, an Obstetric Anaesthetists' Association working group was set up to produce evidence-based guidelines to guide clinicians. These guidelines have been condensed into two review articles. In this second review, the role of an epidural blood patch is discussed using a question and answer format.
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Affiliation(s)
- R Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - C Laxton
- Department of Anaesthetics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - J Niewiarowski
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Scrutton
- Department of Anaesthetics, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - G Stocks
- Department of Anaesthetics, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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Edwards Z, Lucas DN, Gauntlett R. Is training in obstetric critical care adequate? An international comparison. Int J Obstet Anesth 2018; 37:96-105. [PMID: 30482716 DOI: 10.1016/j.ijoa.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/17/2018] [Accepted: 08/29/2018] [Indexed: 01/18/2023]
Abstract
Obstetric critical care is an emerging discipline which cuts across speciality boundaries. We have analysed the training curricula in the three major specialities (obstetrics, anaesthesia and intensive care medicine) likely to be involved in the care of the critically-ill obstetric patient, to assess whether it is adequate to ensure effective training on this subject.
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Affiliation(s)
- Z Edwards
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom.
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom
| | - R Gauntlett
- Department of Anaesthetics, Royal Victoria Infirmary, Newcastle, United Kingdom
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McCall SJ, Bunch KJ, Brocklehurst P, D'Arcy R, Hinshaw K, Kurinczuk JJ, Lucas DN, Stenson B, Tuffnell DJ, Knight M. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population-based descriptive study. BJOG 2018; 125:965-971. [PMID: 29193647 PMCID: PMC6033185 DOI: 10.1111/1471-0528.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK. DESIGN A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). SETTING All consultant-led maternity units in the UK. POPULATION All pregnant women who had anaphylaxis between 1 October 2012 and 30 September 2015. Anaphylaxis was defined as a severe, life-threatening generalised or systemic hypersensitivity reaction. METHODS Prospective case notification using UKOSS. MAIN OUTCOME MEASURES Maternal mortality, severe maternal morbidity, neonatal mortality and severe neonatal morbidity. RESULTS There were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95% CI: 1.1-2.2) per 100 000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co-amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B streptococcal infection accounted for anaphylaxis in one woman. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery (n = 18) there were seven (41%) neonatal intensive care unit admissions, three preterm births and one baby was cooled for neonatal encephalopathy. CONCLUSIONS Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery. TWEETABLE ABSTRACT Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - KJ Bunch
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - P Brocklehurst
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Birmingham Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - R D'Arcy
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - K Hinshaw
- Department of Obstetrics and GynaecologySunderland Royal HospitalSunderlandUK
| | - JJ Kurinczuk
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - DN Lucas
- Department of AnaestheticsNorthwick Park HospitalLondonUK
| | - B Stenson
- Neonatal UnitRoyal Infirmary of EdinburghEdinburghUK
| | - DJ Tuffnell
- Teaching Hospitals Foundation NHS TrustBradfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Egner W, Cook TM, Garcez T, Marinho S, Kemp H, Lucas DN, Floss K, Farooque S, Torevell H, Thomas M, Ferguson K, Nasser S, Karanam S, Kong KL, McGuire N, Bellamy M, Warner A, Hitchman J, Farmer L, Harper NJN. Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) investigation of perioperative anaphylaxis. Clin Exp Allergy 2018; 48:846-861. [DOI: 10.1111/cea.13180] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Affiliation(s)
- W. Egner
- Sheffield Teaching Hospitals NHS Trust; Sheffield UK
- Department of Infection, Immunity and Cardiovascular Disease; University of Sheffield; Sheffield UK
- Royal College of Physicians/Royal College of Pathologists Joint Committee on Immunology and Allergy; University of Sheffield; London UK
| | - T. M. Cook
- Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
- University of Bristol School of Medicine; Bristol UK
- National Audit Projects Program; Royal College of Anaesthetists; London UK
| | - T. Garcez
- United Kingdom Fatal Anaphylaxis Register; Manchester UK
- Manchester University NHS Foundation Trust; Manchester UK
| | - S. Marinho
- Manchester University NHS Foundation Trust; Manchester UK
- British Society of Allergy and Clinical Immunology; London UK
| | - H. Kemp
- Research and Audit Federation of Trainees; London UK
- Imperial College London; London UK
| | - D. N. Lucas
- Obstetric Anaesthetists Association; Harrow UK
- Northwick Park Hospital; Harrow UK
| | - K. Floss
- Royal Pharmaceutical Society of Great Britain; London UK
- Anaesthetics & Critical Care; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - S. Farooque
- Imperial College Healthcare NHS Trust; London UK
| | - H. Torevell
- Bradford Teaching Hospitals NHS Trust; Bradford UK
| | - M. Thomas
- Association of Paediatric Anaesthetists of Great Britain and Ireland; London UK
- Great Ormond Street Hospital; London UK
| | - K. Ferguson
- Association of Anaesthetists of Great Britain and Ireland; London UK
- Aberdeen Royal Infirmary; Aberdeen UK
| | - S. Nasser
- British Society for Allergy and Clinical Immunology; London UK
- Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. Karanam
- Sandwell and West Birmingham NHS Trust; Birmingham UK
| | - K.-L. Kong
- Sandwell and West Birmingham NHS Trust; Birmingham UK
| | - N. McGuire
- Medicines and Healthcare Regulatory Authority; London UK
| | - M. Bellamy
- Leeds Teaching Hospitals NHS Trust; Leeds UK
- Faculty of Intensive Care Medicine; Leeds University; Leeds UK
| | | | - J. Hitchman
- Lay Committee; Royal College of Anaesthetists; London UK
| | - L. Farmer
- Royal College of Anaesthetists; London UK
| | - N. J. N. Harper
- Manchester University NHS Foundation Trust; Manchester UK
- Royal College of Anaesthetists; London UK
- Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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Lucas DN, Meshykhi LS, Nel MR. The role of carbetocin in the prevention and management of postpartum haemorrhage - In reply. Int J Obstet Anesth 2017; 32:91. [PMID: 28689623 DOI: 10.1016/j.ijoa.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
Affiliation(s)
- D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, Harrow, Middlesex, UK.
| | - L S Meshykhi
- Department of Anaesthetics, The Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - M R Nel
- Department of Anaesthetics, The Hillingdon Hospital, Uxbridge, Middlesex, UK
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Affiliation(s)
- D N Lucas
- Northwick Park Hospital, Harrow, Middlesex, UK.
| | - S M Yentis
- Chelsea and Westminster Hospital, London, UK
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Nightingale CE, Margarson MP, Shearer E, Redman JW, Lucas DN, Cousins JM, Fox WTA, Kennedy NJ, Venn PJ, Skues M, Gabbott D, Misra U, Pandit JJ, Popat MT, Griffiths R. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70:859-76. [PMID: 25950621 PMCID: PMC5029585 DOI: 10.1111/anae.13101] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Abstract
Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion.
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Affiliation(s)
| | | | - E Shearer
- Society for Obesity and Bariatric Anaesthesia
| | - J W Redman
- Society for Obesity and Bariatric Anaesthesia
| | - D N Lucas
- Obstetric Anaesthetists' Association
| | - J M Cousins
- Society for Obesity and Bariatric Anaesthesia
| | - W T A Fox
- Society for Obesity and Bariatric Anaesthesia
| | - N J Kennedy
- Society for Obesity and Bariatric Anaesthesia
| | | | - M Skues
- British Association of Day Surgery
| | | | - U Misra
- Obstetric Anaesthetists' Association
| | - J J Pandit
- Association of Anaesthetists of Great Britain & Ireland
| | | | - R Griffiths
- Association of Anaesthetists of Great Britain & Ireland
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Lucas DN, Yentis SM. Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports. Anaesthesia 2015; 70:375-9. [DOI: 10.1111/anae.13034] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. N. Lucas
- Northwick Park Hospital; Harrow Middlesex UK
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