This chapter contains two scenarios relating to general anaesthesia for a category 1 caesarean section.
The first scenario takes the anaesthetist through a straightforward category 1 caesarean section requiring general anaesthesia. This may be used to assess conduct of general anaesthesia for caesarean section as per requirement for the Royal College of Anaesthetists (RCOA) initial assessment of competence in obstetric anaesthesia.
The second scenario is a failed intubation. This is appropriate for all grades of anaesthetists and should be practised with the whole theatre team including obstetricians and midwives.
Scenario 1
Scenario in a Nutshell
General anaesthesia for a category1 caesarean section.
Stage 1: Preparation for a GA category 1 caesarean section.
Stage 2: Induction and maintenance of anaesthesia.
Stage 3: Waking and extubation.
Target Learner Groups
Anaesthetists, midwives, operating department practitioners/anaesthetic nurses, theatre scrub team, obstetricians.
| Specific learning opportunities |
|---|
| Demonstrate competencies around general anaesthesia for caesarean section as described in RCOA 2010 Curriculum – Annex B |
| Effective preparation for and management of induction of general anaesthesia for category 1 caesarean section |
Demonstrate clear communication in the team, particularly the verbalising of Plan A, B and C of the airway strategy, how to contact emergency anaesthetic assistance in case of difficult airway and whether planning to continue surgery using a supraglottic airway or wake the patient up in the event of a failed intubation |
| Suggested learners (to represent their normal roles) | In theatre from the start | Available when requested |
|---|---|---|
| Anaesthetic CT2 | √ | |
| Obstetric ST3+ | √ | |
| Midwife | √ | |
| Operating Department Practitioner (ODP)/anaesthetic nurse | √ | |
| Theatre team – scrub nurse | √ | |
| Theatre team – runner | √ | |
| Suggested facilitators | ||
| Faculty to play role of midwife finishing shift (can be played by facilitator running scenario) | √ |
Details for Facilitators
Patient Demographics
Name: Freya Age: 29 Gestation: 38+4 Booking weight: 78 kg Parity: P0 |
Scenario Summary
29-year-old primiparous woman at 38+4 weeks gestation.
Labouring on Delivery Suite following induction of labour for reduced fetal movements.
Has progressed slowly to 6 cm dilated using entonox for analgesia.
Developed sustained fetal bradycardia resulting in decision for category 1 caesarean section for fetal distress.
Set-up Overview for Facilitators
| Clinical setting | Obstetric theatre |
| Patient position | Just arrived in theatre, being positioned on operating table |
| Initial monitoring in place | None |
| Other equipment | 16G cannula dorsum left hand |
| Useful manikin functions | Intubation |
Medical Equipment
For core equipment checklist, see Chapter 9, including advanced airway equipment.
| Additional equipment specific to scenario | ||
|---|---|---|
|
|
|
|
|
|
Information Given to the Learners
| Information given to anaesthetic trainee and obstetric trainee before they enter theatre |
|---|
| You have both just arrived to start your night shift on delivery unit. As you arrive, you are told that a woman has just been rushed through to theatre for a category 1 caesarean section for a fetal bradycardia. |
| Information given in theatre to anaesthetic trainee, obstetric trainee, theatre team, midwife and obstetrician from midwife who has just transferred the patient to theatre |
| Time: 20:30 |
| The SBAR handover from the transferring midwife is as follows: |
| Situation: This is Freya, who is having a fetal bradycardia. |
| Background: 29-year-old, fit and well primip, BMI 27, who is 38 weeks pregnant with no allergies. She was induced for reduced fetal movements and laboured uneventfully to 6 cm dilatation, then had a fetal bradycardia. She was using entonox for analgesia. |
| Assessment: Observations were all normal. |
| Recommendation: She needs a category 1 caesarean section. |
Scenario Schedule
Suggested Topics for Debrief Discussion
To anaesthetist: did you feel that you prioritised tasks appropriately and got everything prepared in a timely way prior to induction of anaesthesia?
Would you change any aspects of how you did this for your next GA category 1 caesarean section?
How was communication within the theatre team: in particular, prior to induction, did the anaesthetist clearly verbalise:
Plan A, B and C of their airway strategy?
Who their emergency anaesthetic assistance is and how they could be contacted in case of difficult airway?
Plan made to either continue surgery using a supraglottic airway or wake the patient up in the event of a failed intubation?
Scenario 2
Scenario in a Nutshell
Caesarean section under general anaesthesia with failed intubation.
Stage 1: Preparation for a GA category 1 caesarean section.
Stage 2: Induction of anaesthesia and failed intubation.
Stage 3: Difficult mask ventilation, airway rescue with supraglottic airway device, decision to proceed/wake patient.
Target Learner Groups
Anaesthetists, midwives, operating department practitioners/anaesthetic nurses, theatre scrub team, obstetricians.
| Specific learning opportunities |
|---|
| Demonstrate competencies around general anaesthesia for caesarean section as described in RCOA 2010 Curriculum – Annex B |
| Effective preparation for and management of induction of general anaesthesia for category 1 caesarean section |
| Demonstrate clear communication in the team, particularly the verbalising of Plan A, B and C of the airway strategy, how to contact emergency anaesthetic assistance in case of difficult airway and whether planning to continue surgery using a supraglottic airway or wake the patient up in the event of a failed intubation |
| Knowledge of and timely progression through the DAS/OAA failed intubation in obstetrics algorithm |
| Suggested learners (to represent their normal roles) | In theatre from the start | Available when requested |
|---|---|---|
| Anaesthetic CT2 | √ | |
| Anaesthetic ST3+ | √ | |
| Obstetric ST3+ | √ | |
| Midwife | √ | |
| Operating Department Practitioner (ODP)/anaesthetic nurse | √ | |
| Theatre team – scrub nurse | √ | |
| Theatre team – runner | √ | |
| Suggested facilitators | ||
| Faculty to play role of midwife transferring patient to theatre (can be played by facilitator running scenario) | √ |
Details for Facilitators
Patient Demographics
Name: Felicity Age: 32 Gestation: 39+5 Booking weight: 90 kg Parity: P0 |
Scenario Summary for Facilitators
32-year-old, 39+5 weeks gestation primiparous woman.
Labouring spontaneously on Delivery Suite.
Has progressed slowly to 5cm dilated using entonox for analgesia.
Developed sustained fetal bradycardia resulting in decision for category 1 caesarean section for fetal distress.
Requires a general anaesthetic.
Failed intubation occurs.
Able to ventilate with a supraglottic airway.
Decision to wake patient or proceed with caesarean section.
Set-up Overview for Facilitators
| Clinical setting | Obstetric theatre |
| Patient position | Just arrived in theatre, being positioned on operating table |
| Initial monitoring in place | None |
| Other equipment | 16G cannula dorsum left hand |
| Useful manikin functions | Intubation |
Medical Equipment
For core equipment checklist, see Chapter 9, including advanced airway equipment.
| Additional equipment specific to scenario | ||
|---|---|---|
|
|
|
|
|
|
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
