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Chapter 53. Unanticipated Difficult Airway in an Obstetrical Patient Requiring an Emergency Cesarean Section

Which of the following is true with regard to the use of an LMA for the parturient undergoing the cesarean section under general anesthesia?

A. LMA can be used as a rescue device in a parturient with a failed airway undergoing emergency cesarean section.

B. LMA has been shown to be effective and safe in providing ventilation for all parturients undergoing cesarean section.

C. There are no data to support the use of LMA for any parturient undergoing cesarean section.

D. The LMA has been shown to be effective and safe in providing ventilation for obese parturients undergoing cesarean section.

E. Use of LMA is associated with a reduced risk of aspiration for parturients undergoing cesarean section.

(A) While Han et al. has shown that the LMA is effective and safe in providing ventilation and oxygenation to healthy, non-obese, fasted parturients for elective cesarean section, it is generally accepted that the LMA should be used only as an emergency rescue device for failed airway management in the parturient undergoing emergency cesarean section.

What should the anesthesia practitioner do if the vocal cords cannot be seen after two attempts at laryngoscopy in a parturient requiring an emergency cesarean section for placenta previa associated with exsanguinating hemorrhage?

A. awaken the patient and perform an awake fiberoptic intubation

B. awaken the patient and perform the cesarean section under regional anesthesia

C. immediate cricothyrotomy

D. ventilation using BMV or an EGD while maintaining cricoid pressure and if oxygenation is unsatisfactory proceed with the emergency surgical airway

E. reposition the head and neck of the parturient to facilitate further attempts of laryngoscopy

(D) It is imprudent to proceed to a third laryngoscopic attempt. BMV should be attempted while maintaining cricoid pressure. If BMV is unsuccessful, even by easing the cricoid pressure, a rescue device, such as an LMA, should be inserted while concurrently prepared for a surgical airway.

Which of the following is a reasonable approach to minimize the risk of regurgitation and aspiration in a healthy parturient undergoing emergency cesarean section?

A. preoperative oral administration of 0.3 M sodium citrate (30 mL)

B. preoperative IV administration of ranitidine

C. preoperative IV administration ...

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