International Journal of Obstetric Anesthesia - Articles in Press

The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section; 2011 update: implications for the anaesthetist - Corrected Proof

S. Soltanifar, R. Russell — 2012-04-30

Abstract: In 2004 the first National Institute for Health and Clinical Excellence guidelines on caesarean section were published with the aim of providing evidence-based recommendations for best practice. With the publication of new evidence, the guidelines have been revised with the second edition released in 2011. This review highlights the changes that have been made which are of specific relevance to obstetric anaesthetists including planned caesarean section compared with vaginal birth in healthy women with an uncomplicated pregnancy; management of the morbidly adherent placenta; mother-to-child transmission of maternal infections; maternal request for caesarean section; decision to delivery interval for unplanned caesarean section; timing of antibiotic administration and childbirth after caesarean section.

Even SAFER handovers in obstetric anaesthesia - Corrected Proof

A. Carter, J. Allam — 2012-04-27

We would like to thank Dharmadasa et al. for their recent correspondence detailing plans for the introduction of a ‘SAFE’ handover (Sick patients, At risk, Follow-ups, Epidurals) in obstetric anaesthesia at Northwick Park Hospital. The group recognised informal verbal handovers between obstetric anaesthetists in their department had at times led to omission of important clinical information. This is not a concern confined to the north west of London. A national survey from 2006, as referenced in the correspondence, indicated 94% of handovers involved no documentation and a lack of formal structure had led to critical incidents. In addition, documentation to ensure effective handovers would have significant beneficial cost implications for hospitals as indicated in the National Health Service Litigation Authority’s Clinical Negligence scheme guidelines. Subsequent to the introduction of ‘SAFE’ handovers, the group at Northwick Park found that although the proforma tripled the time taken for handover, it increased the proportion of patients handed over from 49% to 79%, suggesting marked improvement in the quality of the handover process. This work was warmly received by the obstetric anaesthetists at Chelsea and Westminster Hospital, and we would like to thank them for what is a simple, effective and very much needed tool on any labour ward.

Failed epidural top-up for cesarean delivery for failure to progress in labor: the plan is to do a single-shot spinal - Corrected Proof

B. Carvalho — 2011-11-23

As a consequence of increasing use of epidurals for labor analgesia, the majority of women in the United States presenting for cesarean delivery during labor will have an epidural in situ. Most clinicians in this setting elect to use the existing epidural to provide cesarean delivery anesthesia. A failed epidural top-up for cesarean delivery in labor is a potentially serious clinical problem that has gained increasing attention recently. The Royal College of Anaesthetists developed guidelines for acceptable rates for failed neuraxial anesthesia for cesarean delivery. The guidelines state that the conversion rate from regional to general anesthesia should be <1% for elective and <3% for non-elective cesarean delivery.

WITHDRAWN: Remifentanil patient-controlled intravenous analgesia for twin pregnancy - Corrected Proof

P. Gowreesunker, F. Roelants — 2010-08-12

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.