General Anaesthesia Practices for Caesarean Deliveries in Johannesburg Academic Hospitals

Abstract

Background General anaesthesia (GA) for caesarean deliveries (C/d) presents unique challenges and complexities, influenced by factors such as clinical indications, resource availability, and evolving practice standards. While neuraxial anaesthesia remains the gold standard, circumstances such as failed neuraxial anaesthesia or emergent scenarios necessitate GA utilisation. However, GA, particularly in low and middle-income countries, raises concerns regarding maternal and perinatal outcomes. Moreover, the scarcity of standardised guidelines exacerbates variability in practice. Against this backdrop, our study aims to evaluate and describe current GA practices for C/d within Johannesburg academic hospitals, examining potential disparities between specialists and non-specialists. By elucidating prevailing practices, our findings will inform the development of localised guidelines, thereby enhancing patient care and fostering consistency in anaesthetic management. Methods A prospective, descriptive, contextual, and cross-sectional study was conducted using a self- administered questionnaire distributed electronically via REDCap®. The questionnaire, based on national and international guidelines, consisted of 35 questions. Participants included medical officers, registrars, and specialist anaesthetists affiliated with the University of Witwatersrand. Results Of 228 eligible participants, 146 responded. Demographic analysis showed most respondents were aware of obstetric guidelines, with ESMOE and OAA/DAS being the most common. Challenges in GA for C/d included airway management, risk of aspiration, and foetal concerns. Induction techniques varied, with propofol and rocuronium increasingly preferred. Analgesic practices differed between specialists and non-specialists, with alfentanil and remifentanil being prominent. The study also explored practices for managing a "cannot intubate, cannot ventilate" scenario during emergency C/d. iv Conclusion Specialists and non-specialists exhibit awareness of obstetric anaesthesia guidelines, but challenges persist in GA for C/d. Variations in airway management, analgesic preferences, and emergency scenario management underscore the need for standardised practices and ongoing evaluation. This study provides valuable insights into current practices and highlights opportunities for improvement in obstetric anaesthesia care