Is it time to revisit tracheal intubation for Cesarean delivery?

Habib, Ashraf S.

doi:10.1007/s12630-012-9719-3

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Most Focus Group members agree that re-applying cricoid pressure is unlikely to be beneficial after placement of a SGD with an esophageal port. After failed tracheal intubation for Cesarean delivery under face mask or SGD ventilation in an emergency, the obstetrician should be requested to make a generous surgical incision and to minimize fundal pressure or use vacuum extraction at the time of delivery 209 (Strong recommendation for , level of evidence B ). With uncomplicated and expeditious surgery, the procedure can be completed with face mask or SGD ventilation.…”

Section: The Obstetric Airway: Special Considerationsmentioning

confidence: 99%

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

324

260

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BackgroundPreviously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered. MethodsNineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria.ConclusionsThe clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.

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Section: The Obstetric Airway: Special Considerationsmentioning

confidence: 99%

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

324

260

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“…These observations should be interpreted cautiously and cannot be extrapolated to emergency situations because above-mentioned studies exclusively included slim, fasted and nonobese parturients for elective caesarean section. In our practice, patients undergoing caesarean section under general anaesthesia are seldom fasted, slim or not in labour [41].…”

Section: Cricoid Pressure and Intubationmentioning

confidence: 99%

“…However, the insertion of an LMA is a valuable alternative in case of a difficult intubation or when maternal risks are associated with tracheal intubation (e.g. in hypertensive emergencies or in patients with severe cardiopathies) [41].…”

Section: Cricoid Pressure and Intubationmentioning

confidence: 99%

General anesthesia for caesarean section

Devroe

Velde

Rex

2015

Current Opinion in Anaesthesiology

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“…124 Hartsilver et al 125 investigated gastric pressures in parturients having emergency CD under GA. This is no longer controversial with respect to delivering the baby if there is ongoing dire maternal or fetal condition.…”

Section: Proceeding With CD With An Unprotected Airwaymentioning

confidence: 99%