All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics (original) (raw)

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.

Successful use of noninvasive ventilation in pregnancy

European Respiratory Review, 2014

Acute respiratory failure (ARF) occurs in less than 0.1% of pregnancies; however, it is one of the most common reasons for obstetric admissions to the intensive care unit (ICU) and carries a high mortality for both mother and fetus. Pulmonary physiological and anatomic adaptations during pregnancy affect the overall management, as well as predispose patients to complications during respiratory illness. Pregnancyrelated upper airway mucosal oedema may obstruct visualisation of the airway during intubation and can make invasive airway management difficult. The pregnant female requiring endotracheal intubation has a four-fold higher risk of having a difficult airway and an eight-fold higher risk of a failed intubation [1].

Difficult and failed intubation: Incident rates and maternal, obstetrical, and anesthetic predictors

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2011

Background Difficult and failed tracheal intubation may be more common in the obstetrical population. The objective of this study was to determine the incidence of difficult and failed tracheal intubation in a Canadian tertiary care obstetric hospital and to identify predictors. Methods Maternal, perinatal, and anesthetic information on all pregnant women or recently pregnant (up to three days postpartum) women undergoing general anesthesia (GA) from 1984 to 2003 at the Izaac Walton Killam Health Centre (IWK) was abstracted from the Nova Scotia Atlee Perinatal Database, and the information was augmented by chart review. The incidence and predictors of difficult and failed tracheal intubation were determined. Analyses using logistic regression were performed for the complete GA cohort and for the subgroup that had Cesarean delivery under GA. Results There were 102,587 deliveries of C20 weeks gestation in the study population, with 3,107 GAs identified, 2,986 records reviewed, and 2,633 GAs (88%) retained in the complete cohort. Difficult tracheal intubation was encountered in 123 of 2,633 (4.7%) women in the complete cohort and 60 of 1,052 (5.7%) women in the Cesarean delivery subgroup. Only two failed tracheal intubations were identified (0.08%) in the complete cohort, and both occurred during GAs for postpartum tubal ligation. The combined rate of difficult/failed tracheal intubation remained stable over the 20 years reviewed despite decreasing GA rates. Amongst the complete cohort, maternal age C35 yr, weight at delivery 90 to 99 kg, and absence of labour predicted increased risks; while weight at delivery 90 to 99 kg and absence of labour amongst the Cesarean delivery subgroup predicted difficult/failed tracheal intubation. Conclusion Previously accepted risk factors, such as labour, pre-existing medical conditions and obstetrical disorders, did not predict an increased risk of difficult tracheal intubation, while maternal age C35 yr, weight 90 to 99 kg, and absence of active labour were found to predict increased risk.

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.

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.

Airway Management during Pregnancy and Labor

Special Considerations in Human Airway Management, 2021

Pregnant women undergo non-obstetric surgeries as well as cesarean operations. Airway management can be complicated due to physiological changes which occur in the respiratory system of labors. The most common causes of pregnancy-specific hypoxic respiratory failure are eclampsia, preeclampsia, and pulmonary edema that develops secondary to tocolytics. Approximately 10–15% of pregnant women undergo emergency cesarean section. Regional anesthesia is a preferred technique worldwide most commonly, and general anesthesia is applied with rapid sequence induction for the rest of the patients. Difficult Airway Society Master Algorithm for Obstetric Patients is a useful method to manage the airway in labors.