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Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. With the increase in the number of cesarean sections performed under regional anesthesia, the experience and training in performing endotracheal intubations in obstetric anesthesia has decreased. This article reviews the management of the difficult and failed airway in obstetric anesthesia. Underpinning this important topic is the difference between the nonpregnant and pregnant state. Obstetric anatomy and physiology, endotracheal intubation in the obstetric patient, and modifications to the difficult airway algorithms required for obstetric patients will be discussed. We emphasize that decisions regarding airway management must consider the urgency of delivery of the baby. Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.

Minute ventilation-sensing pacemakers enable the paced heart to respond to an increased workload. Two patients with such a pacemaker developed pacemaker-driven tachycardia when connected to an electrocardiogram (ECG) monitor also capable of documenting ventilatory frequency and ECG lead disconnection. This tachycardia stopped when the ECG leads were removed. These pacemakers and monitors emit a low-amplitude electrical current and measure the resultant impedence signal across the chest. When patients are connected to the monitor the pacemaker sensor summates both impedence signals and the paced heart rate is increased as a result.

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Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. Reports that were supportive of this technique were based on nonrandomized observational studies with significant selective bias. At the present time, most centers do not routinely offer prophylactic blood patches, and those that do report a variable success rate. A recent case study of permanent neurologic deficit after prophylactic epidural blood patch has also raised some concern about the safety of this prophylactic technique.

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We describe two cases where we attempted to reduce the adverse effects of inadvertent spinal anaesthesia by aspirating local anaesthetic-contaminated cerebrospinal fluid (CSF). Analysis of this CSF for its local anaesthetic concentration revealed that we were able to recover 51% and 39% of the administered lignocaine. It is suggested that such aspiration may be a helpful additional measure to the supportive management of this complication.