British Journal of Anaesthesia 1996;77:559–562 Failed tracheal intubation

Sir,—I read with interest the article by Hawthorne and colleagues detailing failed intubations over 17 yr in a teaching maternity unit1. One result reported was that in only one of seven failed intubations for Caesarean section for fetal distress was neonatal outcome poor. In that instance it was thought that antepartum factors rather than the delay in delivery may have been responsible. Good neonatal outcome despite the considerable delays in delivery that would have occurred in these cases raises the question of the value, if any, of providing general, rather than regional, anaesthesia to expedite Caesarean section for fetal distress. As discussed by Hawthorne and colleagues, general anaesthesia is a potential cause of maternal morbidity and mortality2 3. It also causes increased neonatal respiratory depression and the need for active resuscitation4. Regional anaesthesia may take longer to establish, but this delay does not necessarily cause neonatal morbidity even when the indication for surgery is fetal distress. A study of 212 emergency Caesarean sections by Quinn and Kilpatrick found that the use of a regional anaesthetic technique in cases classified as urgent did not influence the incidence of admission to the special care baby unit5. The authors concluded that while general anaesthesia was indicated for cord prolapse, severe sustained bradycardia and significant antepartum haemorrhage, its use for cardiotocograph diagnosed fetal distress can generally be avoided. General anaesthesia carries considerable risk for mother and baby. Obstetric anaesthetists need to be aware that its use for Caesarean section for fetal distress is often not justified.