Background and Aims Previous work in our department showed a conversion rate of 37% to general anaesthesia (GA) which prompted us to look at factors associated with suboptimal epidural top-ups (ETU) and implement ways to manage them.
Methods Following audit department approval, we retrospectively reviewed patients receiving GA for Caeserean delivery (CD) for 12 months from September 2017. Those converted to GA following an ETU were identified and details regarding epidural insertion, performance in labour, and management of CD were analysed.
Results Of the 266 patients who had a GA for CD, 56 were converted from a failed ETU. There was a wide variation in drugs used for ETU. The most common reason for conversion to GA was pain/discomfort during surgery in 37% of the cases. The time allowed for the block to be ready for surgery was <30 min in 48% of cases. The block height was tested using cold-spray in 57% cases. Only 41% had a block to touch below T5 following ETU. Only 19.5% blocks were salvaged and repeat ETU with intravenous opioid and/or Entonox was the most common method (50%) and even this practice was variable.
Conclusions Confidence in assessing ETU adequacy and salvaging failed ETU needs more work. We have developed a cognitive aid to help with the decision-making and management in the situation of a failed ETU (Figure 1). Prompts will be included on the anaesthetic chart to improve documentation of reasons and methods used to salvage the block. We plan to repeat this project following implementation.