• M Simmons, P Bowie, and L Heatley.
• Inverclyde Royal NHS Trust, Larkfield Road, Greenock.
• Health Bull (Edinb). 1999 Sep 1;57(5):338-43.

ObjectiveTo improve the quality of anaesthesia for caesarean section by assessing the type and reason for using a particular anaesthetic; monitoring the incidence of anaesthetic complications or side effects; and measuring patient satisfaction with anaesthesia provided.DesignRepeat audit undertaken retrospectively using a pre-designed database developed on EPI info public domain software.SettingMaternity unit of a district general hospital.Subjects166 women undergoing emergency or elective caesarean section.ResultsAn initial audit involving 79 patients undergoing emergency and elective caesarean section revealed the following: 58.0 per cent of emergency sections and 45.5 per cent of elective sections were given general anaesthesia; "failure to progress" was indicated as the main reason for caesarean section in 27.8 per cent of cases; 25.3 per cent of patients experienced an anaesthetic-related complication or side-effect; and 90.3 per cent of patients were satisfied with their anaesthesia rising to 97.2 per cent after technical adjustment. The main findings were presented to the multi-disciplinary team staffing the unit. It was agreed that the quality of care could be further improved and changes to anaesthetic practice were quickly introduced. A subsequent re-audit of a further 87 patients showed a number of significant improvements: the overall use of general anaesthesia had fallen to 23.8 per cent from 53.0 per cent (P < 0.05); a noticeable reduction in the number of anaesthetic side-effects and complications had occurred, down from 25.3 per cent to 17.2 per cent of all sections; and patient satisfaction rates with anaesthesia provided were maintained.

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