Airway Management of the Obstetric Patient
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AIRWAY MANAGEMENT (LC BERKOW, SECTION EDITOR)
Airway Management of the Obstetric Patient Shreya Patel 1 & Ashutosh Wali 2 Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this article is to provide current evidence and review guidelines regarding obstetric airway management. Recent Findings Video laryngoscopy (VL) is gaining popularity in obstetric airway management as a primary technique and a rescue technique. Both humidified and high flow nasal cannula (HFNC) are being used for the obstetric difficult airway (DA). Continuing general anesthesia (GA) after successful supraglottic airway (SGA) placement requires awareness and proficiency with different SGAs and SGA-guided flexible bronchoscopic tracheal intubation (SGAFBI). Use of simulation during trainee education improves clinical performance and benefits management of obstetric DA. Summary Difficult or failed airway during cesarean delivery under GA is higher due to pregnancy-related changes and the tense setting. All labor and delivery patients must undergo an airway evaluation. Pertinent resources, including equipment and personnel, must be readily available. Optimal positioning, preoxygenation, and apneic oxygenation help increase safe apnea time and lessen the rapid oxygen desaturation during rapid sequence induction and intubation. Tracheal extubation–related airway complications are the commonest cause of maternal morbidity/mortality following anesthesia. Keywords Pregnancy-related airway changes . Difficult airway management . Apneic oxygenation . Video laryngoscopy use . Second-generation supraglottic airway use . Simulation in obstetrics
Introduction
Incidence of Obstetric Difficult Airway
GA in the pregnant patient (parturient) is challenging due to the anatomic/physiologic changes of pregnancy, increased risk of pulmonary aspiration, and the potential for both maternal and fetal consequences. Management requires knowledge of pregnancy anatomy/physiology, clinical ability to identify and anticipate a DA, experience with various airway devices and techniques to maintain oxygenation, and awareness of human factors involved, as well as familiarity with obstetric DA algorithms should an unrecognized DA be encountered.
Anesthesia-related maternal mortality is the tenth leading cause at 1 per million live births and has declined by 50% between 1987–1990 and 2006–2010 [1]. This decrease is largely due to advancements in respiratory monitoring, development of DA algorithms, and popularity of neuraxial techniques for labor analgesia and surgical anesthesia. However, in the last three decades, cesarean deliveries have increased significantly [2]. Of these, the number performed under GA has decreased significantly due to increased use of neuraxial anesthesia [3]. Up to a third of obstetric GAs are performed for failed neuraxial anesthetic [3, 4]. Of anesthesia-related complications, the incidence of failed intubation is 1 in 390 for all types of obstetric surgery requiri
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