Epidural top-ups for category I/II emergency caesarean section should be given only in the operating theatre

Abstract

If a mother requires emergency caesarean section it is common practice to give her an epidural top-up before she arrives in the operating theatre. Many, if not most, anaesthetists have probably used this technique to shorten the decision-delivery interval, but one should consider whether this practice continues to be appropriate. Many medical practices that were once commonplace have been abandoned. For example, it was once thought acceptable to induce anaesthesia without full monitoring. The perception that there is a safer way of conducting anaesthesia, with a greater margin for error, is enough to change practice. In the field of regional anaesthesia also, the use of full aseptic precautions has increased; this change was not necessarily prompted by the frequent occurrence of infective complications such as epidural abscess or meningitis. The mere existence of these rare yet devastating complications as case reports has been enough to change practice in many quarters. No one would suggest that there is an epidemic of total spinals or local anaesthetic toxicity sweeping across the country because of inadequately managed delivery-room top-ups for caesarean section. However, when a mother does suffer a serious consequence, the rationale for this practice is shaky enough to mean that the practitioner will be hard pressed to defend it.