- Design
- Multicentre prospective cohort
- Population
- 9,989 Caesarean deliveries in 361 centres across 31 European countries, 2023-2025
- Primary outcome
- Anaesthetic technique by urgency category
- Effect
- GA 14.8% overall; 54.0% emergency vs 10.9% elective; neuraxial-to-GA conversion 7.7%
A prospective cohort collected every Caesarean delivery, without exclusions, from 361 centres in 31 European countries between September 2023 and April 2025 (British Journal of Anaesthesia, 9 October 2026). Anaesthetists recorded urgency on a four-category scale.
Of 9,989 deliveries, 14.8% (95% CI 14.0-15.5) involved general anaesthesia. The rate was 54.0% for emergency, 13.8% for urgent, 11.3% for expedited and 10.9% for elective cases. General anaesthesia was the first technique in 7.6%; in elective cases the commonest reason was maternal request (47.0%), and in emergencies it was lack of time for a neuraxial block (58.4%). Conversion from neuraxial to general anaesthesia occurred in 7.7% of neuraxial cases, 23.1% in emergencies and 6.1% even in elective cases.
The authors note the data cannot explain the variation. Still, an elective conversion rate of about 1 in 16 is a figure most units would want to audit against their own, and an emergency general anaesthesia rate over 50% points to where early epidural top-up planning may help.
- Audit your unit's conversion rate from neuraxial to general anaesthesia, including elective cases.
- Plan early with obstetricians to top up working labour epidurals before a category-1 decision where possible.
- Prepare for general anaesthesia in every emergency Caesarean; over half needed it here.
- Explore the reasons behind maternal requests for general anaesthesia at the pre-assessment visit.
- Keep difficult and failed obstetric airway drills current.
Why it matters
It gives a contemporary European benchmark against which units can compare their own general anaesthesia and conversion rates.
Don't overread it
This is descriptive data from voluntary centres; it cannot identify why rates differed or whether they affected outcomes.
The statistics, in plain English
The narrow confidence interval around 14.8% reflects the large sample; individual country or unit rates will vary much more widely.
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