Difficult intubation in pregnancy

Abstract

A scenario-oriented approach to the problem of difficult intubation in pregnant patients leads to the recognition of the unpredicted difficult or failed intubation as the main concern. The appropriate means to cope with this rare but life-threatening complication lies in a gradual employment of principles beginning with preferential application of regional anaesthesia techniques, followed by proceeding according to locally adapted simple and comprehensive failed intubation algorithms, design of a suitable difficult airway cart that contains only a few but well chosen items and by implementation of a continuous and mandatory training program to which all personnel are subjected to participate in regular intervals.

Treatment of oral cancers during pregnancy: a case-based discussion

“…However, it is important to avoid the use of other teratogenic drugs (such as tetracycline antibiotics and phenobarbital) and to control maternal and fetal circulation and respiration intraoperatively. In pregnancy, the body is prone to hypoxemia because functional residual capacity decreases and oxygen consumption increases by approximately 20% [34–36]. Furthermore, since uteroplacental blood flow is not under autonomic regulation, it is important to maintain maternal blood pressure and oxygenation [35].…”

Lumbar neuraxial anatomical changes throughout pregnancy: a longitudinal study using serial ultrasound scans

“…Both spinal and epidural anaesthesia have an important role during pregnancy for obstetric indications arising between 23 and 40 weeks gestation, as well as non‐obstetric surgery at any gestation. General anaesthesia should be avoided whenever possible for fetal protection during all stages of pregnancy and, more specifically, because of airway management concerns during late pregnancy ; thus, effective provision of neuraxial anaesthesia is essential in this patient group. Anaesthetists currently rely on palpating the spinous processes to locate the access point for neuraxial obstetric anaesthesia, but this may be problematic for various reasons including identifying the intervertebral level.…”

Respiratory Diseases of Pregnancy

“…The gravid patient, especially in the third trimester, should be considered a difficult airway patient with high risk of aspiration and decreased oxygen reserve. Other causes of airway obstruction such as tumors, hematoma and laryngeal edema are rarely encountered [20,21].…”