The editorial and article on category-1 caesarean section and rapid sequence spinal anaesthesia [1] prompts me to share the practice adopted in the major Obstetric and Gynaecological Institutions in Chennai, in the state of  Tamilnadu, India.

Since I have been a post graduate trainee in anaesthesia (1976), the technique of anaesthesia for emergency caesarean section has been similar to, or I would say faster than rapid sequence spinal anaesthesia as described in the article by Kinsella et al [1]. No hand washing is done and only gloves are worn after sterilising the hands with medical grade spirit (replaced by sterilium nowadays). The scrub nurse, who is scheduled to assist the surgeon provides the swab with antiseptic for cleaning the patient's back, as well as the spinal needle and the syringe loaded with local anaesthetic. Subarachnoid block is performed with the patient in the lateral position ( to save time in assuming supine position from sitting), and a maximum of 2.5 ml of bupivacaine 0.5% heavy is injected.The surgeon is ready to prepare the patient once the patient is turned to the supine position, and to start surgery, after testing the abolition of pin *** by pinching with dissection forceps. The required level of block up to T8 is achieved in majority of the cases. The only discomfort sometimes experienced by the mother is during application of fundal pressure to deliver the baby, which is managed by a small dose (0.1- 0.2 mg/kg) of ketamine intravenously. No additives are added to the local anaesthetic as a routine. We were forced to adopt this practice because of the large number of cases; on an average 15 to 20 caesarean sections per day. Other techniques of spinal anaesthesia may be time-consuming, and may increase fetal morbidity. This is the reason for the use of the rapid sequence spinal technique that we adopted (although we did not use this name for the procedure). Unfortunately, we have been unable to record timings and other details of the procedure due to workload, as all cases during the day are managed by the same anaesthetist, and this is the reason why we are not able to present our experience as a full article. However, this has been the practice going on for decades in my unit!

Nagaswamy Venkateswaran

Government RSRM Hospital for Woman

Government Stanley Medical College

Chennai

India.

References

1. Kinsella SM, Girgirah K, Scrutton MJL. Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia 2010; 65: 664–669.