The future of general anaesthesia in obstetrics

Abstract

### Key points Until the 1950s, anaesthesia for Caesarean section was performed using an open breathing system with gauze and ether or chloroform. By the mid-1950s, the use of tubocurarine to facilitate tracheal intubation had become common practice. Succinylcholine then became popular because its rapid onset of action avoided some of the dangers associated with the delay in intubating the trachea when tubocurarine was used alone.1 In 1959, thiopental was used for induction of general anaesthesia in obstetrics as part of a technique based only on thiopental, succinylcholine, nitrous oxide, and oxygen (i.e. without the addition of a volatile agent). Cricoid pressure was introduced in 1961, and in 1970, the traditional rapid sequence induction (RSI) was described and halothane was used for maintenance of anaesthesia, alongside nitrous oxide. Apart from the introduction of new volatile agents, there has been almost no change in the practice of general anaesthesia in obstetrics since this time.2 It is well established that central neuraxial block is the gold standard technique for obstetric anaesthesia and understandably this has been the focus of research into improvements in quality and safety. However, in 2014, two major reports were published that call into question certain aspects of modern practice of general anaesthesia in obstetrics: the Fifth National Audit Project (NAP5) which investigated accidental awareness during general anaesthesia (AAGA),3 and the Report on Confidential Enquiries into Maternal Deaths (MBRRACE-UK report).4 General anaesthesia …