Association of Mallampati scoring on airway outcomes in women undergoing general anesthesia with Supreme™ laryngeal mask airway in cesarean section

Abstract

Background Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics. Methods This prospective cohort study was performed at a single-center: Quanzhou Women’s and Children’s Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes. Results The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p < 0.0001). There was no difference in maternal age, ASA status and gestational age. There was similar time to effective ventilation (mean (SD) High MP: 14.9 (4.5) vs Low MP: 15.7 (4.4) seconds, p = 0.2172), and first attempt success rate, seal pressure, and peak airway pressure. No clinical aspiration was noted. The incidence of blood on SLMA was higher in the High MP group than in Low MP (4 (6.6%) vs 4 (0.8%), p = 0.001). There was no difference in sore throat, voice hoarseness, maternal satisfaction and fetal outcomes. Conclusion High MP was not associated with reduced SLMA airway outcomes in cesarean section under general anesthesia, but may increase the risk of blood found on SLMA upon removal. Trial registration This study was registered at http://www.clinicaltrials.gov , identifier: NCT02026882 , retrospectively registered. Date of registration: December 31, 2013.

The effects of labor on airway outcomes with Supreme™ laryngeal mask in women undergoing cesarean delivery under general anesthesia: a cohort study

“…However, Boutonnet et al reported that Mallampati scores remain unchanged for 37% of parturients in labor [7], and our study may not be adequately powered to detect a significant change in Mallampati scores. Nonetheless, we have previously shown that Mallampati scores of 3 or 4 did not significantly affect time to effective ventilation, first attempt failure rate, or sLMA seal pressure compared to parturients with Mallampati scores of 1 or 2 undergoing cesarean delivery [21].…”

“…This is a secondary analysis of a prospective cohort study investigating the use of sLMA during cesarean delivery [18]. With this dataset, we had previously published the association of Mallampati scores on airway outcomes with sLMA use for cesarean delivery [21]. Approval was obtained from the Institutional Review Board at the Quanzhou Women's and Children's Hospital, Fujian Province, China, (dated 11 Nov 2013) and registered with clinicaltrials.gov (NCT02026882) on 3 January 2014.…”

The role of supraglottic airway devices in obstetric anaesthesia

“…However, since 2001, the use of SGA as primary airway device during GA for CD has been demonstrated in several studies and been reviewed on several occasions [8][9][10][11][12][13][14][15][16][17]19,43 && ,44,45 && ,46]. To date, there are at least twelve peer reviewed studies describing the use of SGA as primary airway device (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19]. Eight articles describe the use of SGA as a primary airway device during elective CDs under GA [8,9,[11][12][13][14]18,19], three studies report the use of SGA in elective and emergency caesarean deliveries [10,16,17] and one study in emergency cases only [15].…”

“…To date, there are at least twelve peer reviewed studies describing the use of SGA as primary airway device (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19]. Eight articles describe the use of SGA as a primary airway device during elective CDs under GA [8,9,[11][12][13][14]18,19], three studies report the use of SGA in elective and emergency caesarean deliveries [10,16,17] and one study in emergency cases only [15]. Cricoid force was applied in all but one study during induction of GA, but its use during the maintenance phase of anaesthesia was variable, with some releasing it after insertion of the SGA or if ventilation was compromised and others releasing after the delivery of the baby.…”

“…In obstetric practice, SGA are confined to use as a rescue airway device when failed intubation occurs [1,7 & ]. More recently, SGAs have been used as the primary airway device for elective and emergency caesarean delivery (CDs) in carefully selected patient cohorts [8][9][10][11][12][13][14][15][16][17][18][19]. This review aims to discuss the place of SGAs in obstetric anaesthetic practice and review the available literature.…”