A survey of practice of rapid sequence induction for caesarean section in England.
BACKGROUND
In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England.


METHODS
In 2017, 316 questionnaire surveys were posted to all 158 hospitals with caesarean section capabilities in England. At each hospital, one questionnaire was to be completed by the obstetric anaesthetic consultant lead and one by an anaesthetic trainee. Differences in responses between consultants and trainees, regardless of their place of work, were compared for all data using the chi-square and the Fisher's exact tests.


RESULTS
One-hundred-and-eighty complete questionnaires were returned, with an overall response rate of 57%, 98 (54%) from obstetric anaesthetic consultant leads and 82 (45.6%) from trainees). Both head up (57%) and ramped (56%) were the preferred positions for preoxygenation. Less than half of respondents (43%) preoxygenated until the surgeon was scrubbed. Cricoid pressure was used by almost all respondents (98%). Thiopentone (67%) was the most commonly chosen anaesthetic induction agent and most respondents (82%) supported a change to the use of propofol. Suxamethonium (92%) was the neuromuscular blocker of choice but more than half the respondents (52%) supported a change to rocuronium. In the event of a failed intubation, the rescue supraglottic airway device of choice was the i-gel® (65%).


CONCLUSIONS
Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom.
['Desai|N|N|', 'Wicker|J|J|', 'Sajayan|A|A|', 'Mendonca|C|C|']
D000773:Anesthesia, Obstetrical D002585:Cesarean Section D004739:England D005260:Female D019538:Health Care Surveys D006801:Humans D007442:Intubation, Intratracheal D010818:Practice Patterns, Physicians' D011247:Pregnancy D011795:Surveys and Questionnaires
Preoxygenation Obstetrics Positioning General anaesthesia Induction anaesthetics Neuromuscular blocking drugs Opioids