There should be a locally agreed neuraxial analgesia record and a protocol for the prescription and administration of drugs.
When the anaesthetist is informed of a request for neuraxial analgesia (and the circumstances would be suitable for this type of analgesia) the anaesthetist should attend within 30 minutes of being informed. Only in exceptional circumstances should this period be longer, and in all cases attendance should be within one hour. This should be the subject of regular audits.27,115
When remifentanil PCA is provided as an alternative to neuraxial analgesia, there should be local multidisciplinary guidelines.116
Midwives caring for women receiving remifentanil PCA should be trained specifically in the use of the technique, and stay with the woman continuously without any break in observation. Remifentanil PCA should only be provided in units where it is frequently used. Rapid reversal of respiratory depression/arrest and airway resuscitation equipment should be immediately available.
As a result of the assessment, the appropriate level of postoperative care can be determined and booked in a day surgery facility, ward, high dependency unit (level 2 care) or critical care unit (level 3 care), enabling both optimum care and efficient planning
There should be a clear line of communication between the duty anaesthetist, theatre staff and anaesthetic assistant once a decision is made to undertake an emergency caesarean delivery.
The anaesthetist should be informed about the category of urgency of caesarean delivery at the earliest opportunity.117
A World Health Organization (WHO) checklist adapted for maternity should be used in theatre.118
Before induction of general anaesthesia, there should be a multidisciplinary discussion about whether to wake the woman or to continue with anaesthesia in the event of failed tracheal intubation.119
