Anaesthetic choice in the colposcopy clinic: a retrospective analysis of routinely collected data

Sir,

Swancutt et al.¹ have reported their findings that 20.5% of their women attending for colposcopy treatment are receiving treatment under general anaesthesia compared with the recommended 20% under national guidelines.²

The colposcopy service at Sheffield Teaching Hospitals received 980 referrals in 2007. Data extracted from colposcopy and theatre databases have shown that, in total, 585 treatments of all types, as defined in the colposcopy guidelines,² were carried out, of which 64 (14%) were carried out under general anaesthesia. These data include all types of treatment under general anaesthesia, including knife cone biopsies, which comprised 31 (8%) treatments. However, comparison with our data from 2005 shows that the rate of treatment under general anaesthesia has fallen from 125/585 (21%).

It is difficult to compare this general anaesthetic rate with the data provided by Swancutt et al. because they do not define what they have included as a treatment. However, our recent data does show a large difference when compared with the Birmingham data, and our own data from a similar period. This further highlights the need for more work to be carried out to determine what is a typical rate for treatment under general anaesthesia because this seems to vary between departments and over time. This needs to be linked to reasons for performing treatments under general anaesthesia and understanding variations in that rate. It serves as a reminder that the current guidelines are based solely on expert opinion and that much wider information is needed to determine whether, in fact, we should be aiming for a general anaesthetic rate for cervical treatments that is far lower than 20%.