Obstetric Airway Management Guidelines
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The obstetric anaesthetists' association and difficult airway society have created national guidelines for managing difficult tracheal intubation during general anaesthesia in obstetrics. Key points include the importance of patient positioning, management of oxygenation after failed intubation, and the utility of videolaryngoscopy when the anaesthetist is trained in it. The document also highlights pregnancy-related factors that contribute to airway challenges, such as increased regurgitation risk and anatomical changes.
Obstetric Airway Management Guidelines
- 1. The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia.
- 2. KEY POINTS : ● The decline in general anaesthesia for Caesarean section has reduced many anaesthetists' experience and confidence in obstetric airway management. ● Correct patient positioning and pre-oxygenation is essential to provide optimal conditions for intubation. ● Oxygenation and ventilation are the main priorities after failed intubation. ● Videolaryngoscopy may be useful in obstetric airway management but only if the anaesthetist is familiar with the technique. ● Knowing when to abandon each step of the failed intubation drill and move on to the next is vital.
- 3. PREGNANCY-RELATED FEATURES THAT MAY CONTRIBUTE TO AIRWAY DIFFICULTIES Problem Cause High risk of regurgitation of gastric contents and acid aspiration syndrome Reduced lower oesophageal sphincter tone and increased intra-gastric pressures Gastric emptying delayed by labour and opioids Increased gastric acid volume and acidity Rapid onset of hypoxaemia after induction FRC reduced by 20% (more when supine) Oxygen consumption increased by 25% (up to 60% during labour) Difficulty inserting the laryngoscope blade Enlarged breasts Weight gain/obesity Poor view at laryngoscopy Misplaced cricoid pressure and/or misaligned laryngoscopy due to lateral tilt to reduce aorto-caval compression Airway oedema due to increased total body water and reduced colloid oncotic pressure Exacerbated by pre-eclampsia Risk of bleeding from airway manipulation Capillary engorgement of nasal and oropharyngeal mucosa Coagulopathy in pre-eclampsia
- 5. Head elevated (ramped position).