Anaesthetic management of a patient with multiple pterygium syndrome for elective caesarean section

Daga, V.; Mendonca, Cyprian; Choksey, F.; Elton, John S.; Radhakrishna, S.

doi:10.1016/j.ijoa.2017.04.005

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…Caesarean section was usually scheduled for obstetric indications, though some reports mentioned that it was chosen: to avoid labour or vaginal delivery [12,14,37,41]; due to increased respiratory compromise in late pregnancy [20,[43][44][45]63]; or in combination with definitive surgery for the airway lesion [17,40]. In some patients, it was stated specifically that an elective caesarean section was performed because airway management was deemed too difficult should emergency caesarean section and general anaesthesia be required [33,46,50].…”

Section: Antenatal Planningmentioning

confidence: 99%

“…The use of sedation and topical anaesthesia techniques was highly variable. Oxygen was provided by facemask, nasal cannulae or by high-flow humidified nasal oxygenation at 50-60 l.min À1 [49,50].…”

Section: Awake Tracheal Intubation Using the Flexible Bronchoscopementioning

confidence: 99%

“…Other features / tests included: neck movement (mentioned 75 times); mouth opening (68); thyromental distance (36); and jaw protrusion/micrognathia (24). One report mentioned assessment of the neck in case front-ofneck access was required [50], and two reports mentioned obstructive sleep apnoea or snoring [15,139]. No publication recorded the use of a combined score [141].…”

Section: Airway Assessmentmentioning

confidence: 99%

“…A common observation in all the above cases was that the patients were morbidly obese, and the anaesthetist expected difficulties in tracheal intubation and facemask ventilation. Videolaryngoscopy has also been used as a primary technique or after failure of other approaches [50,61].…”

Section: Awake Tracheal Intubation Using Other Devicesmentioning

confidence: 99%

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Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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Section: Resultsmentioning

confidence: 99%