Planning the obstetric airway

McGuire, B.; Lucas, D.N.

doi:10.1111/anae.14987

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…The guidelines suggest consideration should be given to presenting general anaesthesia as a viable alternative to neuraxial blockade. Given the risks of failed tracheal intubation, hypoxaemia, pulmonary aspiration and awareness, this may not form part of the typical consent process for many obstetric anaesthetists [14]. While regional anaesthesia is generally preferable, women should be aware there is a choice and that general anaesthesia should not be perceived as a failure on either the part of the mother or the anaesthetist [15].…”

Section: Consent For Anaesthesia For Caesarean Sectionmentioning

confidence: 99%

“You test because you cannot afford to make assumptions”

McGlennan

Christmas

2022

Anaesthesia

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Section: Consent For Anaesthesia For Caesarean Sectionmentioning

confidence: 99%

“You test because you cannot afford to make assumptions”

McGlennan

Christmas

2022

Anaesthesia

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“…En el caso de las pacientes obstétricas, la intubación despierta es la opción más segura, si se espera una vía aérea difícil, particularmente, si también se anticipa ventilación con máscara dificultosa (2). De hecho, las guías de la Sociedad de Vía Aérea Difícil (DAS) para intubación despierto en adultos recomiendan que la intubación traqueal despierto sea considerada en la presencia de predictores de vía aérea difícil, aunque no se trate de embarazadas (14). Asimismo, en aquellos casos en los cuales se sospeche vía aérea difícil, se deben considerar métodos avanzados: el fibrobroncoscopio óptico flexible (FOB) por vía oral (para evitar epistaxis) es el método estándar en este tipo de pacientes.…”

Section: A Vía Aérea Difícil Sospechadaunclassified

Consideraciones en el manejo de la vía aérea en embarazadas

2021

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La anatomía y fisiología de las mujeres embarazadas sufre modificaciones en la mayoría de sistemas del cuerpo, pero algunos de los cambios más significativos son los que ocurren a nivel respiratorio, los cuales convierten a las pacientes obstétricas en una potencial vía aérea difícil. Esto debe ser identificado mediante una evaluación completa de la vía aérea previo a la manipulación de esta, al igual que como se realiza en pacientes no gestantes. Posterior a dicha valoración, es preciso aplicar los algoritmos que han sido diseñados para orientar el manejo de la ventilación e intubación en este tipo de pacientes, por ejemplo, las guías publicadas por la Asociación de Anestesiólogos Obstétricos y la Sociedad de Vía Aérea Difícil, siempre con el objetivo de preservar al máximo el bienestar materno y fetal.

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“…The recommendation to consider elective cesarean section in women with anticipated need of awake fiberoptic intubation in institutions, where such airway experts are not available 24/7 has provoked critique and questioned the qualification of such institutions to care for these women 7. Although I agree that in an ideal world labour ward is staffed 24/7 with neuraxial regional anesthesia experts and airway experts in awake fiberoptic intubation, I think reality does sometimes look different.…”

Section: Commentmentioning

confidence: 99%

Anticipated Difficult Airway During Obstetric General Anesthesia: Narrative Literature Review and Management Recommendations

Mushambi¹,

Athanassoglou²,

Kinsella³

2021

Obstetric Anesthesia Digest

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As frontline healthcare workers (in my case a Maternal Fetal Medicine specialist still working in labor and delivery), it easy to feel helpless when facing such a monumental problem that seems too big and complex to handle. Many of the causes of this disparity occur outside of the healthcare system and before we even meet our patients. However, it would be too easy to place the blame entirely on things outside of our control. This study is the perfect example of how we can address this crucial issue from different angles and start to narrow the gap in outcomes between women of different racial and ethnic groups.The authors conducted a large-scale cross-sectional study, looking at outcomes of a hemorrhage quality improvement (QI) collaborative among 99 hospitals across California. They evaluated impact of the implementation of 17 evidence-based national recommendations for maternal hemorrhage and assessed whether it would narrow the gap in rates of severe maternal morbidity (SMM) from hemorrhage. The results are both encouraging and troubling. They are encouraging because they show that standardized protocols and QI initiatives are effective in reducing the rates of SMM across all groups as well as decreasing the disparity gap. However, it is also troubling to see these results as they show that a significant part of the problem is related to the care we provide our patients in labor and delivery units. When looking at SMM from maternal hemorrhage, it is tempting to think that the difference in outcomes between different patient populations is related to lack of access to adequate prenatal care. Antenatal treatment of anemia and recognition of placental accreta spectrum disorders are examples of conditions in which appropriate prenatal care would improve outcomes. However the authors show that regardless of prenatal care, a standardized protocol for obstetrical hemorrhage decreases the gap in SMM between black and white women.This study is a wake-up call for anyone who still thinks that frontline healthcare providers cannot make a difference in this systemic issue. Standardized protocols have been shown to improve outcomes across all patient populations and especially disadvantaged communities.

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Planning the obstetric airway

Cited by 6 publications

References 21 publications

“You test because you cannot afford to make assumptions”

“You test because you cannot afford to make assumptions”

Consideraciones en el manejo de la vía aérea en embarazadas

Anticipated Difficult Airway During Obstetric General Anesthesia: Narrative Literature Review and Management Recommendations

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