Management of the obstetric airway — time for a paradigm shift (or two)?

Preston, Roanne

doi:10.1016/j.ijoa.2015.08.002

Cited by 8 publications

(11 citation statements)

References 30 publications

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“…1 The overall incidence of difficult orotracheal intubation was 4.2% (CI 2.7-6.5%), with 6 failed orotracheal intubations, and is higher than a combined reported incidence of 0.26% (CI 0.2-0.3%) 1 ; however, no cesarean was canceled because all of the failed orotracheal intubation parturients received either rescue laryngeal mask airways or mask anesthesia to maintain parturient oxygenation. 1,15 Any therapeutic intervention should be evaluated with probability measures for success or harm. These probability measures can be expressed with risk and proportion differences in which the therapeutic intervention is compared in one or more groups.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Airway Management for Cesarean Delivery: Use of Risk and Proportion Differences

King¹,

Morello²,

Clark³

et al. 2022

Southern Medical Journal

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Objectives: Securing the parturient airway is essential during general anesthesia for cesarean delivery. The purpose of this study was to compare inferior airway views provided by the use of three commonly available laryngoscopy blades-Macintosh, Miller, or Glidescope Mac-Styleto the incidence of difficult orotracheal intubation.Methods: Following institutional review board approval, data from 449 electronic medical records in parturients undergoing general anesthesia for cesarean delivery were extracted during a 6-year period. The association of these blades with difficult orotracheal intubation was analyzed with risk and proportion differences measures of effect size. Results:The overall incidence of difficult orotracheal intubation was 4.2% (95% confidence interval 2.7 − 6.5%), with 6 failed orotracheal intubations (5 laryngeal mask airways rescues and 1 mask rescue). Clinically important increases in risk differences for difficult orotracheal intubation were observed in parturients with restricted mouth openings, modified Mallampati III and IV views, and reduced thyromental distances. When modified Cormack-Lehane views were grouped into III and IV versus I and II cohorts; proportion differences for difficult orotracheal intubation were dependent upon the type of blade used, with the Miller blade providing the lowest proportion difference.Conclusions: Miller blade laryngoscopy provided the lowest proportion difference for difficult orotracheal intubation during general anesthesia for cesarean delivery. Miller blade laryngoscopy provides effective procurement of the parturient airway.

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Section: Discussionmentioning

confidence: 99%

Analysis of Airway Management for Cesarean Delivery: Use of Risk and Proportion Differences

King¹,

Morello²,

Clark³

et al. 2022

Southern Medical Journal

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“…All SADs should allow an easy transition to intubation without the need to remove the airway, which may be required during general anaesthesia for caesarean section. 140 Aside from a ready supply of pillows for routine ramping, no new or alternative equipment is required for DATs in the obstetric difficult airways setting 141 (Strong recommendation for, level of evidence moderate quality).…”

Section: Difficult Airway Equipment For Obstetric Anaesthesiamentioning

confidence: 99%

Updated guideline on equipment to manage difficult airways: Australian and New Zealand College of Anaesthetists

Endlich

Hore

Baker

et al. 2022

Anaesth Intensive Care

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The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways ) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper ), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.

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“…Another area of current interest is ultrasound in airway management. Following the publication of the Obstetric Anaesthetists’ Association / Difficult Airway Society guidelines for the management of the potential difficult and failed tracheal intubation in obstetrics , there has been renewed discussion in this area . These guidelines have moved the focus of attention after failed intubation away from continued intubation attempts to maintaining oxygenation including front‐of‐neck airway access in a ‘can't intubate, can't oxygenate’ situation.…”

Section: Airway Managementmentioning

confidence: 99%

“…The use of ultrasound as a device to aid the prediction of a difficult airway has been encouraging but inconclusive , but more promising is its use to aid accurate location of the cricothyroid membrane. It has been stated that the view that a needle cricothyrotomy is an ‘easy rescue airway that can be left to the bitter end’ persists , but the evidence that cricothyroid puncture is a reliable and safe rescue technique is limited. In a review of the management of failed tracheal intubation during obstetric general anesthesia covering 45 years of published data, six of 13 cases of attempted front‐of‐neck procedures died .…”

Section: Airway Managementmentioning

confidence: 99%