Institutional readiness to deliver total intravenous anaesthesia for obstetric patients: a national Irish survey.

Total intravenous anaesthesia is a core safety standard for absolute indications, such as malignant hyperthermia susceptibility, yet little is known about institutional readiness to deliver total intravenous anaesthesia for obstetric patients. We conducted a national cross-sectional service evaluation of all 19 Irish maternity units via the Irish Society of Obstetric Anaesthesia network. Responses were received from 13/19 units, representing over 80% of the national birth activity. Most units (8/13) reported reliable access to target-controlled infusion pumps and processed electroencephalography monitoring (12/13), but 5/13 had fewer than one target-controlled infusion pump per obstetric theatre and 4/13 lacked an immediate backup pump. No unit had a written protocol for obstetric total intravenous anaesthesia, and 7/13 reported no resident training. Reported total intravenous anaesthesia use for obstetric general anaesthesia was low (0% in 8/13 units). Lack of exposure (11/13) and institutional preference for volatile agents (10/13) were the most common barriers. Readiness to deliver total intravenous anaesthesia for obstetric patients without delay is variable across Irish maternity units. Given that total intravenous anaesthesia remains mandatory in certain high-risk patient groups, including those susceptible to malignant hyperthermia, deficiencies in equipment redundancy, monitoring, training and governance are patient safety concerns which should be addressed.