Background: Airway difficulty is a major contributor to mortality and morbidity during caesarean section (CS) under general anaesthesia. Though general anaesthesia is safe, the changes associated with pregnancy make securing airway more difficult. The purpose of this study was to investigate the pattern and factors associated with airway difficulty in the parturient in the region. Methods: This was a retrospective, descriptive study of parturients who suffered airway difficulty during caesarean section under general anaesthesia over seven-year period. Their medical records were reviewed and data collected included total CS done under general anaesthesia, age, weight, nature of airway difficulty, coexisting diseases, and timing of surgery, outcomes and Apgar scores. Data was analysed using SPSS version 23 for Windows®. Results: General anaesthesia was used in 51.3% of 10,275 CS with 42 documented as “difficult airway” giving 0.8% incidence and incidence ratio of 1:125. Failed intubation was recorded in 58% while difficult intubation was 42% of those with difficult airway. Among these, the CS was in 55% of cases “emergent”. The mean age was 33.32±5.96 years. The weight ranged from 60 to 163kg. Over 58% weighed more than 90kg. In 50% of cases, the airway was rescued with LMA and in 50%, reintubation succeeded. Outcome was good for mother and fetus in all cases. Conclusion: Obstetric airway difficulty remains a valid concern. Effort should be made to use regional anaesthesia to reduce the risk. High awareness and preparation during obstetric general anaesthesia are recommended.
Motor neuron disease (MND) is a progressive neurodegenerative disease of unknown aetiology, which results in weakness of muscles of phonation, ambulation, deglutition and respiration. It has low prevalence but high disability and fatality. Death often follows respiratory failure. There is no known cure. It is extremely rare in pregnancy, but when it occurs, the respiratory compromise worsens and anaesthesia becomes challenging. There is no consensus yet on the choice of anaesthesia. We present a 29-year-old, 32-week parturient with MND who presented with severe dyspnea, orthopnea and was diagnosed with severe respiratory distress. She was admitted into ICU and given anticoagulant and steroid therapy. Sequential mini-dose combined spinal-epidural anaesthesia (CSE) was given and surgery performed in the semi-sitting position successfully. There was no deterioration of symptoms post anaesthesia. We conclude that CSE is adequate to manage parturient with MND who has severe orthopnea following respiratory muscle paresis.
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