General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study*

Pan-London Perioperative Audit and Research Network (PLAN), for the DREAMY Investigators Group

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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%).

Original languageEnglish (US)
Pages (from-to)460-471
Number of pages12
Issue number4
StatePublished - Sep 21 2020
Externally publishedYes

Bibliographical note

Funding Information:
Registered at Identifier (NCT03100396). We wish to thank the allied trainee research networks that helped support this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri‐operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). This work was supported by an Obstetric Anaesthetists’ Association research grant. JP was the clinical lead for the 5th National Audit Project (NAP5). NL chairs the Obstetric Anaesthetists’ Association Education subcommittee and is an Editor for the . No other external funding or competing interests declared. International Journal of Obstetric Anesthesia

Publisher Copyright:
© 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.


  • airway management
  • caesarean section
  • general anaesthesia
  • obstetrics


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