Desai N, et al. - Via an online survey, researchers investigated the optimal management of a failed epidural top up for cesarean delivery, by comparing different management strategies proposed by members of the Obstetric Anaesthetists’ Association in the United Kingdom. By the majority of the respondents (89%), they would think of topping up an existing labor epidural for a category-one cesarean section. The category of cesarean section (92%), dermatomal level of blockade (78%), and the evaluation of maternal airway were identified as the most influential factors determining further anesthetic management in the setting of a failed epidural top up. In the presence of no objective sensory block (74%), bilateral T10 sensory block (57%), or unilateral T6 sensory block (45%) resulting from an epidural top up, the commonly favored option was spinal anesthesia. The respondents opted for a lower dose of intrathecal local anesthetic when the sensory block level was higher or unilateral, and increasingly preferred alternative options such as combined-spinal epidural and general anesthesia. Overall, a need for guidelines to aid decision-making is highlighted by the observed variations in management strategies for clinically tackling a failed epidural top up for cesarean delivery.