RT Book, Section
A1 Greenidge, Kamilla
A1 Segal, Scott
A2 Santos, Alan C.
A2 Epstein, Jonathan N.
A2 Chaudhuri, Kallol
SR Print(0)
ID 1108523233
T1 Anesthetic Complications due to Airway Management/Aspiration
T2 Obstetric Anesthesia
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071786133
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1108523233
RD 2024/04/19
AB The  term  difficult  airway  most  commonly  refers  to  difficulty  in  placing  an  endotracheal  tube  through  the  vocal  cords  with  the  use  of  direct  laryngoscopy.  However,  it  can  also  refer  to  difficulty  in  providing  adequate  mask  ventilation.1  Despite  advances  in  airway  management  and  rescue,  the  incidence  of  airway  difficulty  encountered  in  the  pregnant  population  resulting  in  inability  to  intubate  is  still  estimated  by  some  to  be  1  in  300,  a  value  eight  times  higher  than  that  seen  in  the  general  population.2,  3,  and  4  In  the  past,  aspiration  was  considered  a  major  cause  of  maternal  morbidity  and  mortality.5  It  follows  that  complications  of  airway  management  and  failed  or  difficult  intubation  after  induction  of  general  anesthesia  in  near  term  pregnant  women  may  be  significant  contributors  to  anesthesia-related  maternal  complications,  and  avoidance  of  difficult  airway  scenarios  be  of  paramount  concern  to  the  obstetric  anesthesiologist.  Indeed,  failure  to  intubate  was  the  leading  cause  of  anesthesia  related  maternal  mortality  from  1979  to  1990.6  Historically,  this  has  led  anesthesiologists  to  reduce  the  use  of  general  anesthesia  and  thus  the  rate  of  airway  catastrophe  at  the  time  of  induction  of  general  anesthesia  for  cesarean  delivery.  More  recently,  however,  because  of  improved  difficult  airway  protocols  and  rescue  equipment,  including  the  use  of  the  laryngeal  mask  airway,  increased  use  of  regional  anesthesia,  and  overall  increased  awareness,  the  maternal  death  rate  from  airway  complications,  particularly  at  induction  of  general  anesthesia,  appears  to  be  decreasing.7,8  The  following  discussion  focuses  on  airway  and  gastrointestinal  changes  in  pregnancy,  managing  the  difficult  airway,  and  aspiration.