RT Book, Section
A1 Ratto, Christina
A1 Muir, Holly A.
A2 Hung, Orlando R.
A2 Murphy, Michael F.
SR Print(0)
ID 1202479061
T1 Unanticipated Difficult Airway in an Obstetrical Patient Requiring an Emergency Cesarean Section
T2 Hung’s Management of the Difficult and Failed Airway, 4<sup>th</sup> Edition
YR 2024
FD 2024
PB McGraw Hill
PP New York, NY
SN 9781264278329
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1202479061
RD 2024/10/13
AB A  25-year-old  primigravida  at  39  weeks  gestational  age  presents  to  the  labor  and  delivery  floor  with  ruptured  membranes  and  frequent  uterine  contractions.  She  does  not  want  to  have  epidural  analgesia  because  of  a  story  she  heard  about  an  epidural  complication  suffered  by  one  of  her  distant  relatives.  After  14  hours  of  labor  augmented  with  oxytocin,  and  now  2  hours  of  pushing,  she  is  urgently  taken  to  the  operating  room  for  emergency  cesarean  section  because  of  prolonged  late  decelerations.  She  weighs  253  lbs  (115  kg)  and  is  5′3″  (160  cm)  tall,  giving  her  a  BMI  of  approximately  45  kg·m–2.  Airway  examination  on  admission  revealed  a  Mallampati  II  and  a  thyromental  distance  of  4  cm.  She  has  full  neck  extension  with  normal  dentition  and  a  normal  mouth  opening.  On  arrival  in  the  operating  room,  her  Mallampati  score  is  now  assessed  to  be  a  grade  III.  She  has  large  gravid  breasts.  Her  blood  pressure  is  128/68  mmHg,  heart  rate  100  beats  per  minute  (bpm),  respiratory  rate  20  breaths  per  minute,  and  SaO2  of  99%  on  a  100%  oxygen  via  a  non-rebreather  face  mask.  On  arrival  in  the  operating  room,  the  fetal  heart  rate  is  80  bpm.