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Keywords: maternal outcomes; obstetric anaesthesia; process metrics; quality indicators EN maternal outcomes obstetric anaesthesia process metrics quality indicators 573 575 3 04/14/20 20200501 NES 200501 The aim of delivering high-quality clinical care that optimises patient outcomes has always been a driving principle in the practice of medicine. This shortcoming related to quality indicators, outlined above, is not unique; a systematic review of published studies of quality indicators in anaesthesia found that 64% were process indicators, and that patient-centred metrics accounted for the fewest published clinical indicators [1]. [Extracted from the article]

Neuraxial anaesthesia is widely used in obstetrics and neurological complications are rare. However, when they occur, subsequent investigation and management are time-critical and correlate with the extent of neurological recovery. The Third National Audit Project recommended the implementation of guidelines in obstetric epidural management, including advice on monitoring for early signs of problems and acting upon concerns. However, no national guideline exists for postoperative management in the obstetric population. We conducted a national survey of monitoring after obstetric neuraxial blockade and the management of an abnormally prolonged block. We received responses from 112/189 (59.3%) obstetric anaesthetic leads invited to participate. We determined that post-neuraxial blockade monitoring in the UK is highly variable: only 63/112 (56.3%) respondents' units had a monitoring policy in place, although most of these did not undertake formal neurological monitoring, and a range of different monitoring methods and schedules were employed. In 12/63 (19%) local policies, the first review of neurology was performed at the standard postoperative visit the following day, and 66/112 (58.9%) units had no protocol in place to address emergency management of abnormally prolonged neuraxial blockade. Where a policy was in place, the initial recommended action and the type of imaging used were variable. [ABSTRACT FROM AUTHOR]

The authors discuss the impact of the reports on anesthesia by the 5th National Audit Project (NAP5) and by the Mothers and Babies: Reducing Risk Through Audit and Confidential Enquiries Across the UK (MBRRACE-UK) on obstetric general anesthesia. Topics discussed include cases of awareness in obstetric anesthesia, recommendations of the reports for anaesthetists, and a forecast for general anaesthesia.

Serious neurological lesions such as vertebral canal haematoma are rare after obstetric regional analgesia/anaesthesia, but early detection may be crucial to avoid permanent damage. This may be hampered by the variable and sometimes prolonged recovery following 'normal' neuraxial block, such that an underlying lesion may easily be missed. These guidelines make recommendations for the monitoring of recovery from obstetric neuraxial block, and escalation should recovery be delayed or new symptoms develop, with the aim of preventing serious neurological morbidity. [ABSTRACT FROM AUTHOR]