Chapter 52. Airway Management of the Obstetrical Patient with an Anticipated Difficult Airway
Which of the following is NOT a physiological change of pregnancy that would impact on the airway management of the patient?
A. increase in oxygen consumption
C. increase risk of aspiration
D. decrease in alveolar-arterial oxygen gradient
E. increase in closing volume
(D) All of the physiological changes of pregnancy listed are correct except the alveolar-arterial oxygen gradient which is increased in pregnancy. This abnormality can persist in the immediate postpartum period.
All of the following are potential problems of preeclampsia on the parturient airway EXCEPT
A. severe upper airway edema
B. friable airway and thus very unforgiving if multiple attempts at intubation are required
C. pharyngeal narrowing that could contribute to difficulty in blind intubating techniques
D. bronchoscopic intubation under indirect vision is contraindicated because of the potential airway bleeding
E. blind nasotracheal intubation will inevitably lead to considerable bleeding
(D) Friable and easily bleeding airway, upper airway edema, pharyngeal narrowing are potential problems of preeclampsia on the parturient airway. Awake intubation using a flexible bronchoscope is an acceptable technique for preeclamptic parturient with an anticipated difficult airway.
Which of the following is a reasonable intubating technique for an obese parturient with severe preeclampsia and a history of difficult laryngoscopic intubation?
A. awake bronchoscopic intubation
B. laryngoscopic intubation following a rapid sequence induction
C. awake intubation using a lightwand
D. awake blind nasal intubation
E. intubation through an intubating LMA under general anesthesia
(A) For an obese parturient with severe preeclampsia and a history of difficult laryngoscopic intubation, awake bronchoscopic intubation is the most reasonable technique among these choices.