Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method

Leboulanger, Nicolas; Louvet, Nicolas; Rigouzzo, A.; Mesmay, M. de; Louis, Bruno; Farrugia, M.; Girault, Laure; Ramirez, Adriana; Constant, Isabelle; Jouannic, Jean‐Marie; Fauroux, Brigitte

doi:10.1016/j.ijoa.2013.08.008

Cited by 23 publications

(7 citation statements)

References 30 publications

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“…This change was paralleled by a reduction in the cross-sectional area of the pharynx, whereas minimal and mean tracheal cross-sectional areas remained unaffected [8]. Difficult intubation was observed with a frequency of 1 : 238 to 1 : 100 in a study by Djabatey and colleagues.…”

Section: Airway Managementmentioning

confidence: 92%

“…According to Leboulanger et al [8] higher Mallampati classes (III and IV) were found in 12% of the women during the first trimester, a figure that rose to 20% during the second trimester, which is the preferred time for nonurgent surgery. This change was paralleled by a reduction in the cross-sectional area of the pharynx, whereas minimal and mean tracheal cross-sectional areas remained unaffected [8].…”

Section: Airway Managementmentioning

confidence: 96%

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Nonobstetric anesthesia during pregnancy

Heesen

Klimek

2016

Current Opinion in Anaesthesiology

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Section: Airway Managementmentioning

confidence: 92%

Section: Airway Managementmentioning

confidence: 96%

Nonobstetric anesthesia during pregnancy

Heesen

Klimek

2016

Current Opinion in Anaesthesiology

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“…These changes result in increasing Mallampati score as pregnancy progresses, and also during labour and delivery [14][15][16][17][18]. Swelling may be exacerbated by pre-eclampsia [19,20], oxytocin infusion, intravenous fluids and Valsalva manoeuvres during labour and delivery [15,16,21].…”

Section: Classification Of Evidencementioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe 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. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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“…The mucosa of the upper respiratory tract becomes more vascular and oedematous, leading to increased risk of airway bleeding and swelling. These changes result in increasing Mallampati score as pregnancy progresses, and also during labour and delivery . Swelling may be exacerbated by pre‐eclampsia , oxytocin infusion, intravenous fluids and Valsalva manoeuvres during labour and delivery .…”

Section: Why Is Airway Management More Difficult In the Obstetric Patmentioning

confidence: 99%

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

et al. 2015

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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. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method

Cited by 23 publications

References 30 publications

Nonobstetric anesthesia during pregnancy

Nonobstetric anesthesia during pregnancy

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

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