Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

General anesthesia for emergency caesarean delivery: simulation-based evaluation of residents

Anestesia geral para cesariana de emergência: avaliação de residente com base em simulação

Júlio Alberto Rodrigues Maldonado Teixeira, Cláudia Alves, Conceição Martins, Joana Carvalhas, Margarida Pereira

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Decreased rates of General Anesthesia (GA) for Caesarean Section (C-section) create a learning problem for anesthesia trainees. In this context, training the management of GA for C-section using simulation techniques allows a safe environment for exposure, learning, performance improvement, and capability retention.

Analyze anesthesia residents’ performance regarding a simulated clinical case of GA for emergency C-section and identify specific deficits in skill acquisition.

Between 2015 and 2018, we evaluated the performance of 25 anesthesiology residents challenged by a simulated clinical case of GA for emergency C-section after the conclusion of the obstetric anesthesia rotation. Each resident performed the clinical case once followed by the assessment of their performance. Final scores were given according to the completion rate of 14-tasks, going from 0% to 100%. Two study groups were considered according to residency year for subsequent comparison of results (Group 1, second and third residency years and Group 2, fourth and fifth residency years).

Results and discussion
Mean score was 64.29% ± 13.62. Comparatively, Group 1 obtained a higher score than Group 2 (70.63% ± 14.02 vs. 60.27% ± 11.94), although with no statistically significant difference (p =  0.063). The tasks most frequently accomplished were opioid administration (100%), rapid sequence technique (100%), pre-oxygenation (92%), gastric content aspiration prophylaxis (84%), and previous clinical history (84%). Conversely, the tasks less frequently accomplished were confirming presence of pediatrician (64%), oxytocin administration (56%), PONV prophylaxis (56%), and preoperative airway assessment (48%).

The performance of the residents observed in this study was comparable to results previously published. The final score did not depend on the residency year.


General anesthesia,  Emergency cesarean,  Simulation,  Resident evaluation


1 T. Boerma, C. Ronsmans, D.Y. Melesse, et al. Global epidemiology of use of and disparities in caesarean sections Lancet, 392 (2018), pp. 1341-1348

2 B.A. Bucklin, J.L. Hawkins, J.R. Anderson, F.A. Ullrich Obstetric anesthesia workforce survey: twenty-year update Anesthesiology, 103 (2005), pp. 645-653

3 C.M. Ortner, P. Richebé, L.A. Bollag, B.K. Ross, R. Landau Repeated simulation-based training for performing general anesthesia for emergency cesarean delivery: long-term retention and recurring mistakes Int J Obstet Anesth, 23 (2014), pp. 341-347

4 B.M. Scavone, P. Toledo, N. Higgins, K. Wojciechowski, R.J. McCarthy A randomized controlled trial of the impact of simulation-based training on resident performance during a simulated obstetric anesthesia emergency Simul Healthc, 5 (2010), pp. 320-324

5 S. Lipman, B. Carvalho, J. Brock-Utne The demise of general anesthesia in obstetrics revisited: prescription for a cure Int J Obstet Anesth, 14 (2005), pp. 2-4

6 N.M. Tofil, J. Dollar, L. Zinkan, et al. Performance of anesthesia residents during a simulated prone ventricular fibrillation arrest in an anesthetized pediatric patient Paediatr Anaesth, 24 (2014), pp. 940-944

7 D.J. Murray Current trends in simulation training in anesthesia: a review Minerva Anestesiol, 77 (2011), pp. 528-533

8 L.A. Schornack, C.L. Baysinger, M.C.M. Pian-Smith Recent advances of simulation in obstetric anesthesia Curr Opin Anaesthesiol, 30 (2017), pp. 723-729

9 R.H. Blum, S.L. Muret-Wagstaff, J.R. Boulet, et al. Simulation-based assessment to reliably identify key resident performance attributes Anesthesiology, 128 (2018), pp. 821-831

10 B.M. Scavone, M.T. Sproviero, R.J. McCarthy, et al. Development of an objective scoring system for measurement of resident performance on the human patient simulator Anesthesiology, 105 (2006), pp. 260-266

11 G.R. Lorello, D.A. Cook, R.L. Johnson, R. Brydges Simulation-based training in anaesthesiology: a systematic review and meta-analysis Br J Anaesth, 112 (2014), pp. 231-245

12 C.S. Park Simulation and quality improvement in anesthesiology Anesthesiol Clin, 29 (2011), pp. 13-28

13 A.K. Wong Full scale computer simulators in anesthesia training and evaluation Can J Anaesth, 51 (2004), pp. 455-464

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