Evaluation of surgical and anaesthesia response times for crash caesarean sections--an audit of a Singapore hospital.
BACKGROUND
The Royal College of Obstetricians and Gynaecologists published the "Organisational Standards for Maternity Services" in 1995, in which they proposed that there be a maximum decision-to-delivery time of 30 minutes for urgent caesarean sections (CS). In 1997, our institution established a protocol for extremely urgent ("crash") CS to expedite delivery time and to conform to this standard.


METHODS
The objective of this prospective audit was to determine the surgical and anaesthesia response times in our institution after the protocol had been implemented. The audit was conducted in KK Women's and Children's Hospital from February 2003 to January 2004, over a 12-month period. Upon activation of a "crash" CS, the attending anaesthetist was required to record the decision-to-anaesthesia time, decision-to-delivery time and the perinatal outcome.


RESULTS
Ninety-eight cases of "crash" CS were identified from a total of 3629 elective and non-elective CS, with 80 cases having complete data. The mean decision-to-delivery interval was 7.7 min+/-3.0 (SD) with 100% of deliveries made within 17 minutes. The mean decision-to-anaesthesia time was 3.5 min+/-2.0 (SD) with all the patients anaesthetised within 10 minutes. The majority (88.8%) of the patients had general anaesthesia for "crash" CS while the rest had successful epidural block extension. There was no significant difference in the decision-to-delivery interval or mean cord blood pH with respect to the type of anaesthesia given.


CONCLUSIONS
We achieved 100% deliveries within the proposed 30-minute decision-to-delivery time interval by implementing a protocol for "crash" CS. Both general anaesthesia and extension of existing epidural block are acceptable modes of anaesthesia and do not delay delivery of the fetus.
Lim
Y
Y
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore. yvel6@hotmail.com
Shah
M K
MK
Tan
H M
HM
D000773:Anesthesia, Obstetrical / Q000592:standards*; D002585:Cesarean Section / Q000379:methods*; D003657:Decision Making; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D011247:Pregnancy; D011446:Prospective Studies; D012846:Singapore; D013997:Time Factors