‘Cannot Intubate and Cannot Ventilate’- Emergency Tracheostomy in a Case of Eclampsia , as a Life Saving Procedure (original) (raw)
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Indian journal of anaesthesia, 2016
The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or co...
Special Article: Failed intubation in obstetrics
Failed intubation is prevalent in obstetric patients, more so during the last trimester of pregnancy when physiological factors may worsen the problems that lead to difficult intubation. If securing the airway is not managed efficiently it may have disastrous effects on mother and the fetus. During last few years, management of airway in obstetrics and training in this field has undergone numerous changes. The postgraduate students have been getting lesser exposure to intubation in pregnant patients. As regional anesthesia is increasingly popular in obstetrics, acquiring dexterity in conducting general anesthesia is becoming difficult. There should be a methodical approach to train in managing difficult obstetric airway. Various novel airway devices are now being suggested as an alternative to conventional intubation using laryngoscope. In addition, devices such as simulators should be employed to so that difficult or failed intubation may be managed with required skill. Other vital aspects to deal with this situation include a difficult airway cart that contains alternative airway devices, a comprehensive but practically easy algorithm and a regular drill or training to deal with difficult airway in obstetric patients.
Anesthetic management of a patient presenting with eclampsia
aer, 2013
Eclampsia is one of the most common emergencies encountered by anesthesiologists which involve a safe journey of two lives. The defi nition, etiology, pathophysiology, treatment guidelines along with a special reference to management of labour pain and caesarean section are discussed. Eclampsia is commonly faced challenging case in our day to day anaesthesia practice,but less is discussed in our anaesthesia text books. Lot of controversies with regard to fl uid management and monitoring still remain unanswered
Difficult intubation in the parturient
Canadian Journal of Anaesthesia, 1989
Difficult or failed tracheal intubation is an important cause of anaesthetic-related maternal morbidity and mortality. The incidence of failed iatubation in parturients is estimated to be as frequent as 1 in 500; that of mortality is unknown, although some 10-13 pregnant women in England, Scotland and Wales die each year because of anaesthetic-related complications. To prevent such catastrophes, all necessary monitors and equipment should be available, including that needed to deal with a failed intubation. Assessment of the patient may lead to preoperative recognition of a difficult airway; altered positioning may be of help both in recognition and management. Furthermore, adequate assistance, correct use of cricoid pressure, and confirmation of tracheal intubation are fundamental to safe practice. Lastly, should the anaesthetist fail to intubate the patient's trachea, a management protocol is suggested.
Difficult Airway in Obstetric Anesthesia: A Review
Obstetrical and Gynecological Survey, 2001
Failed intubation and ventilation are important causes of anesthetic-related maternal mortality. The purpose of this article is to review the complex issues in managing the difficult airway in obstetric patients. The importance of prompt and competent decision making in managing difficult airways, as well as a need for appropriate equipment is emphasized. Four case reports reinforce the importance of a systematic approach to management. The overall preference for regional rather than general anesthesia is strongly encouraged. The review also emphasizes the need for professional and experienced team cooperation between the obstetrician and the anesthesiologist for the successful management of these challenging cases. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to break down the complex issues in managing the difficult airway in the obstetric patient, outline the reasons for difficult intubations in pregnancy, and describe the evaluation used to predict a difficult intubation.
Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach
Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of “time”.
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Background: Ectopic pregnancy is a health problem in women of reproductive age whose products of conception implant outside the endometrium. Fluid resuscitation and maintenance and adequate treatment in intensive care unit can reduce mortality and morbidity in patients. Case presentation: A 19-year-old woman came to the emergency department of Dr. M. Djamil General Hospital Padang with complaints of pain in the lower abdomen for 8 hours before entering the hospital. Physical examination results and obtained anemic conjunctiva (+)/(+). Check-up result in deep vaginal touch (VT) was obtained portion rocking pain (+). Then inspection culdosynthesis with results (+). The patient was diagnosed with acute abdominal ec suspected ruptured ectopic pregnancy at G2P1A0H1 gravid 8-9 weeks with severe anemia. After undergoing laparotomy, the patient was admitted to the ICU for 2 days. Conclusion: Adequate resuscitation of fluids and blood products and overcoming shock causes are crucial in mana...
2016
Background: We describe the management of a pregnant female with preeclampsia, who presented at 33 weeks gestation in respiratory distress secondary to compression from a multinodular goiter. Results: A multidisciplinary team was assembled, including anesthesiology, maternal fetal medicine, otolaryngology, and cardiothoracic surgery. The patient underwent a cesarean section followed by a total thyroidectomy for removal of the compressive thyroid goiter. Cardiothoracic surgery was included in this particular case because of the risk for acute loss of the airway, which could have necessitated cardiopulmonary bypass. Conclusions: Airway obstruction from extra-tracheal compression in the setting of preeclampsia represents a unique management dilemma. Successful results can occur with a multidisciplinary approach to airway management.