Difficult and Failed Tracheal Intubation in Obstetrics: A Seven-year Review in a Saudi Maternity Hospital

Abstract

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.