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King A, Morello J, Clark A, Ray A, Martel C, McLendon R, McConville A, Russo M, Germond L, Nossaman B. Analysis of Airway Management for Cesarean Delivery: Use of Risk and Proportion Differences. South Med J 2022; 115:198-201. [PMID: 35237838 DOI: 10.14423/smj.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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-Style-to 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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Affiliation(s)
- Andrew King
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Justin Morello
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Allison Clark
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Adrienne Ray
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Colleen Martel
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Roneisha McLendon
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Anne McConville
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Melissa Russo
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Liane Germond
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
| | - Bobby Nossaman
- From the Department of Anesthesiology, University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana
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Baker PA, Hounsell GL, Futter ME, Anderson BJ. Airway Management Equipment in a Metropolitan Region: An Audit. Anaesth Intensive Care 2019; 35:563-9. [DOI: 10.1177/0310057x0703500416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Difficult airway equipment containers are commonly found in operating rooms, but the availability of airway equipment beyond that environment is unknown. Using the Difficult Airway Society (U.K.) and American Society of Anesthesiologists’ guidelines, we conducted an inspection audit of airway equipment at all anaesthetic sites in our region. Staff knowledge about the equipment was assessed and feedback was provided to each site. Eighteen of the 42 sites had an airway container. Equipment for an unexpected difficult intubation, according to the guidelines, was deficient at all sites. Equipment to detect oesophageal intubation was inadequate. Locations remote from the operating suite lacked emergency invasive airway equipment and were, on average, a 4.3 minute walk from the nearest appropriate equipment. Two clinics had no emergency invasive airway equipment. Half of the airway containers with check lists had items missing. One third of the items with an expiry date were expired. Quality control and implementation of airway guidelines could rectify these deficiencies. Anaesthesia organisations should be encouraged to publish detailed equipment guidelines.
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Affiliation(s)
- P. A. Baker
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
| | - G. L. Hounsell
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
- Department of Anaesthesia, Middlemore Hospital
| | - M. E. Futter
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
- Intensive Care Specialist, Paediatric Intensive Care Unit
| | - B. J. Anderson
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
- Intensive Care Specialist, Paediatric Intensive Care Unit
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3
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Gandhi KA, Jain K. Management of anaesthesia for elective, low-risk (Category 4) caesarean section. Indian J Anaesth 2018; 62:667-674. [PMID: 30237591 PMCID: PMC6144555 DOI: 10.4103/ija.ija_459_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An increasing number of caesarean sections are being performed for both elective as well as emergency cases. Category 4 caesarean section refers to a planned elective surgery after 39 weeks of gestation at a time suitable to the mother and the maternity team. For a safe conduct of anaesthesia, the updated obstetric anaesthesia guidelines recommend administration of neuraxial anaesthesia, whenever feasible. The management should include adequate postoperative pain relief, early ambulation, and thromboprophylaxis to ensure early recovery. This review will discuss the anaesthetic management including regional anaesthesia, general anaesthesia, and postoperative analgesia for elective, low-risk (Category 4) caesarean section.
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Affiliation(s)
- Komal Anil Gandhi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Burns During Pregnancy: Implications for Maternal-Perinatal Providers and Guidelines for Practice. Obstet Gynecol Surv 2016; 70:633-43. [PMID: 26490163 DOI: 10.1097/ogx.0000000000000219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE When a major burn is suffered during pregnancy, the obstetric provider is challenged to respond on an evidence basis because personal experience usually is lacking. Currently, there is a paucity of publications to inform the obstetrician, guide practice, and impact early critical decision making. OBJECTIVE The aims of this study were to summarize the available information on early management of burns during pregnancy and to identify components of best practices for optimal outcome. EVIDENCE ACQUISITION The PubMed database was searched for relevant titles and abstracts involving pregnant patients suffering from second-/third-degree burns. Among these studies, the bibliographies were investigated for further relevant literature. A total of 114 studies were identified during the initial search, and only studies published in English and French were included for a total of 42. Variable data were available for 1141 patients, with complete data for 139 cases. Mediation and regression analysis were used for available data. Insufficient data were available to undertake a systematic review. RESULTS Total body surface area of burns (TBSAB) was positively associated with maternal death, and the odds of maternal mortality increase by 1.08 per percentage increase of TBSAB (P < 0.001). Fetal survival depends on maternal survival (P ≤ 0.001). Maternal survival declines incrementally when TBSAB exceeds 55%, and inhalation injury further exacerbates maternal-perinatal risk. CONCLUSIONS Emergent assessment of the pregnant burn victimincludes determination of gestational age, extent of TBSAB, presence of inhalation injury, and continuous fetal monitoring. If gestational age is 24 weeks or longer and TBSAB exceeds 55%, urgent cesarean delivery appears desirable for the mother and baby. RELEVANCE A specific analysis of maternal-perinatal outcome based on TBSAB and gestational age is relevant to obstetric and emergency providers who provide care to pregnant burn patients.
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Plöckinger U, Tiling N, Bosanska L, Temmesfeld-Wollbrueck B, Irlbacher K, Mezger V, Gossing G. Multiple, Successful Pregnancies in Pompe Disease. JIMD Rep 2015; 28:111-118. [PMID: 26572913 DOI: 10.1007/8904_2015_518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 12/03/2022] Open
Abstract
Pompe disease is an autosomal recessive lysosomal storage disease characterized in adult patients by slowly progressive limb-girdle muscle weakness and respiratory insufficiency. Data on pregnancy in women with Pompe disease, intrauterine development of the fetus and parturition are rare. Here we describe a twin pregnancy followed by a second pregnancy in a 38-year-old female patient with Pompe disease. We report the impact of pregnancy on muscle and respiratory functions as well as the neurological and endocrine systems and discuss the medical consequences for anaesthetic management at parturition.
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Affiliation(s)
- Ursula Plöckinger
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Nikolaus Tiling
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lenka Bosanska
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrueck
- Med. Klinik m. S. Infektiologie und Pneumologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Kerstin Irlbacher
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Viktor Mezger
- Klinik für Anästhesiologie m. S. Operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Gabriele Gossing
- Klinik für Gynäkologie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Hendrie M, Kumar M. Airway obstruction, caesarean section and thyroidectomy. Int J Obstet Anesth 2013; 22:340-3. [DOI: 10.1016/j.ijoa.2013.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 05/14/2013] [Accepted: 06/01/2013] [Indexed: 11/25/2022]
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8
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Leboulanger N, Louvet N, Rigouzzo A, de Mesmay M, Louis B, Farrugia M, Girault L, Ramirez A, Constant I, Jouannic JM, Fauroux B. Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method. Int J Obstet Anesth 2013; 23:35-9. [PMID: 24333051 DOI: 10.1016/j.ijoa.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/06/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. METHODS We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery. RESULTS Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P < 0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P< 0.001). CONCLUSION Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.
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Affiliation(s)
- N Leboulanger
- Department of Head and Neck Surgery, Armand-Trousseau Hospital, Université Paris, Paris, France.
| | - N Louvet
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - A Rigouzzo
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - M de Mesmay
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - B Louis
- INSERM, Unité U955, and CNRS, ERL 7240, Paris, France
| | - M Farrugia
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - L Girault
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - A Ramirez
- Department of Pulmonology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - I Constant
- Department of Anesthesiology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - J-M Jouannic
- Department of Obstetrics and Gynecology, Armand-Trousseau Hospital, Université Paris, Paris, France
| | - B Fauroux
- Department of Pulmonology, Armand-Trousseau Hospital, Université Paris, Paris, France
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Abstract
Approximately 1% to 4% of pregnant women are evaluated in emergency/delivery room because of traumatic injury, yet there are few educational strategies targeted toward prevention/management of maternal trauma. Use of illicit drugs and alcohol, domestic abuse, and depression contribute to maternal trauma; thus a high index of suspicion should be maintained when treating injured young women. Treating the mother appropriately is beneficial for both the mother and the fetus. Fetal viability should be assessed after maternal stabilization. Pregnancy-related morbidity occurs in approximately 25% of cases and may include placental abruption, uterine rupture, preterm delivery, and the need for cesarean delivery.
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Affiliation(s)
- Sharon Einav
- Hebrew University School of Medicine, Shaare Zedek Medical Centre, Jerusalem, Israel.
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11
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Borràs R, Periñan R, Fernández C, Plaza A, Andreu E, Schmucker E, Añez C, Valero R. [Airway management algorithm in the obstetrics patient]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:436-443. [PMID: 22947195 DOI: 10.1016/j.redar.2012.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Affiliation(s)
- R Borràs
- Departamento de Anestesiología y Reanimación, Institut Universitari Dexeus, Barcelona, España.
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12
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The effect of laryngoscope handle size on possible endotracheal intubation success in university football, ice hockey, and soccer players. Clin J Sport Med 2012; 22:341-8. [PMID: 22627651 DOI: 10.1097/jsm.0b013e318257c9a8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of a standard long-handle laryngoscope and a short-handle laryngoscope on ease of possible intubation in football, ice hockey, and soccer players. DESIGN Prospective crossover study. SETTING University Sport Medicine Clinic. PARTICIPANTS Sixty-two university varsity football (62 males), 45 ice hockey (26 males and 19 females), and 39 soccer players (20 males, 19 females). INTERVENTIONS Athletes were assessed for different airway and physical characteristics. Three different physicians then assessed the use of laryngoscopes of different handle sizes in supine athletes who were wearing protective equipment while in-line cervical spine immobilization was maintained. MAIN OUTCOME MEASURES The ease of passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was assessed using both a standard long-handle and a short-handle laryngoscope. RESULTS Use of a short-handle laryngoscope was easier for all physicians in all sports as compared with a standard-sized laryngoscope. Passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was easiest in soccer players and most difficult in football and ice hockey players for both sizes of laryngoscope. Interference from chest or shoulder pads was a common cause for difficulty in passing the laryngoscope blade into the posterior oropharynx for football and ice hockey players. CONCLUSIONS In the rare instances that an endotracheal intubation is to be attempted on an unconscious athlete, a short-handle laryngoscope may provide the best chance for successful intubation.
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Viktorsdottir O, Barth WH, Hartnick C, Pian-Smith MCM. Severe glottic stenosis in a parturient with ectodermal dysplasia. Int J Obstet Anesth 2012; 21:273-6. [PMID: 22658712 DOI: 10.1016/j.ijoa.2012.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 04/05/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
Airway stenosis in pregnancy is challenging and the literature does not offer consensus regarding its evaluation and anesthetic management. A 21-year-old nulliparous woman with ectodermal dysplasia and severe glottic stenosis was referred to the obstetric anesthesia team for evaluation and peripartum management recommendations. She had a history of a congenital complete glottic web that required a tracheostomy at birth. After decannulation at age four, she was lost to follow-up. On examination in early pregnancy, she was found to have a dangerously narrow airway with fixed vocal cords and a glottic aperture of 2-3mm. At nine weeks of gestation an elective tracheostomy was performed under local anesthesia. She later underwent an uneventful cesarean delivery under spinal anesthesia. Ultimately, early interdisciplinary planning for an elective tracheostomy helped assure patient safety during advancing pregnancy and delivery.
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Affiliation(s)
- O Viktorsdottir
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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14
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el Shobary H, Gauthier M, Schricker T. Jet ventilation for the excision of vocal cord polyps in a pregnant patient. Anaesth Intensive Care 2011; 39:1136-8. [PMID: 22165372 DOI: 10.1177/0310057x1103900625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The anaesthetic management of patients presenting with laryngeal tumours and airway obstruction is difficult. We present the case of a pregnant woman at 30 weeks gestation who underwent surgical removal of two vocal cord polyps under general anaesthesia using jet ventilation
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Affiliation(s)
- H el Shobary
- Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada
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15
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Abstract
PURPOSE OF REVIEW This review focuses on difficult intubation in pregnant patients, particularly during the late pregnancy when physiological, patho-physiological and psychological factors may cause or aggravate difficulties with providing sufficient oxygenation and securing the airway. It is intended to highlight the methodological approach to the difficult airway in this particular patient population and to draw relevant principles in dealing with this problem. RECENT FINDINGS There are strong indications for improvement in the outcome of airway management in pregnant patients; however, this is obscured by the growing frequency of caesarean sections and connected to this by more tracheal intubations. Various new airway devices have been suggested as alternative techniques for laryngoscopic intubation if the latter becomes difficult or failed. SUMMARY 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.
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Gestion des voies aériennes en obstétrique. ACTA ACUST UNITED AC 2011; 30:651-64. [DOI: 10.1016/j.annfar.2011.03.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/24/2011] [Indexed: 11/21/2022]
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baker PA, Flanagan BT, Greenland KB, Morris R, Owen H, Riley RH, Runciman WB, Scott DA, Segal R, Smithies WJ, Merry AF. Equipment to manage a difficult airway during anaesthesia. Anaesth Intensive Care 2011; 39:16-34. [PMID: 21375086 DOI: 10.1177/0310057x1103900104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway complications are a leading cause of morbidity and mortality in anaesthesia. Effective management of a difficult airway requires the timely availability of suitable airway equipment. The Australian and New Zealand College of Anaesthetists has recently developed guidelines for the minimum set of equipment needed for the effective management of an unexpected difficult airway (TG4 [2010] www.anzca.edu.au/resources/professionaldocuments). TG4 [2010] is based on expert consensus, underpinned by wide consultation and an extensive review of the available evidence, which is summarised in a Background Paper (TG4 BP [2010] www.anzca.edu.au/ resources/professional-documents). TG4 [2010] will be reviewed at the end of one year and thereafter every five years or more frequently if necessary. The current paper is reproduced directly from the Background Paper (TG4 BP [2010]).
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Affiliation(s)
- P A Baker
- Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia
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Suggested algorithm for management of the unexpected difficult airway in obstetric anesthesia. J Clin Anesth 2009; 21:385-6. [DOI: 10.1016/j.jclinane.2008.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 12/18/2008] [Accepted: 12/18/2008] [Indexed: 11/23/2022]
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Rahimi M, Makarem J. Effects of Diclofenac Epolamine Patch on Postoperative Sore Throat in Parturients After Cesarean Delivery Under Endotracheal General Anesthesia. ACTA ACUST UNITED AC 2009; 47:17-21. [DOI: 10.1016/s1875-4597(09)60015-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van Zundert A, Kuczkowski KM, van Zundert T, Meeusen V. The art of maintaining a patent airway: an old problem — new evidence. Can J Anaesth 2008; 55:380-1. [DOI: 10.1007/bf03021495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Direct laryngoscopy and endotracheal intubation in the prone position following traumatic thoracic spine injury. J Anesth 2008; 22:170-2. [PMID: 18500616 DOI: 10.1007/s00540-007-0596-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
Abstract
Perioperative airway management in trauma victims presenting with penetrating thoracic spine injury poses a major challenge to the anesthesiologist. To avoid further neurological impairment it is essential to ensure maximal cervical and thoracic spine stability at the time of airway manipulation (e.g., direct laryngoscopy and endotracheal intubation). Airway management in the prone position additionally increases the incidence of cervical/thoracic spine injury, difficult ventilation, and difficult airway instrumentation. Although awake fiberoptic intubation of the trachea is considered the gold standard for airway instrumentation in patients with posterior thoracic/cervical trauma, this technique requires the patient's cooperation, special equipment, and extensive training, all of which might be difficult to accomplish in emergency situations. We herein present the first reported case of an adult trauma patient who underwent direct laryngoscopy and endotracheal intubation under general anesthesia in the prone position. Although the prone position is not the standard position for airway instrumentation with direct laryngoscopy and endotracheal intubation under general anesthesia, our experience indicates that this technique is possible (and relatively easy to perform) and might be considered in an emergency situation.
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Kuczkowski KM. A situation pregnant with danger:Trauma in pregnancy. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ní Mhuireachtaigh R, O'Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 2006; 18:60-6. [PMID: 16517336 DOI: 10.1016/j.jclinane.2004.11.009] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2002] [Accepted: 11/10/2004] [Indexed: 11/22/2022]
Abstract
Anesthesiologists in every subspecialty encounter, with varying regularity, patients presenting for surgery during the course of pregnancy. With the increasing sophistication of surgical and anesthetic techniques, increasingly complex surgeries are being undertaken. In this review, we address the fundamental physiologic principles central to the care of pregnant patients and fetuses in this difficult clinical situation.
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Abstract
Critically ill pregnant and postnatal women admitted to intensive care units (ICUs) require highly specialised care, components of which many critical care nurses are unfamiliar with. There are no specialist critical care obstetric centres in Australia, with critically ill obstetric patients admitted to general ICUs. There are no published guidelines and little research that assist critical care nurses to care for such women. Furthermore, the admission of pregnant or postnatal women to ICUs is likely to increase with emerging childbearing patterns in Australia. It is therefore timely to review what we know about caring for critically ill pregnant and postnatal women. This paper analyses the literature on intensive care utilisation by obstetric patients and provides an overview regarding which pregnant and postpartum women require intensive care. The key areas of providing mechanical ventilation to pregnant women and assessment of fetal wellbeing are explored in detail. The most frequent conditions and their treatment, preeclampsia and obstetric haemorrhage, are also reviewed. The establishment of lactation is also considered as the critical carenurse is commonly involved in supporting the woman's endeavour to breastfeed.
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Rall M, Dieckmann P. Safety culture and crisis resource management in airway management: general principles to enhance patient safety in critical airway situations. Best Pract Res Clin Anaesthesiol 2006; 19:539-57. [PMID: 16408533 DOI: 10.1016/j.bpa.2005.07.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Airway management is a cornerstone of patient safety in anaesthesiology and in emergency and critical care medicine. Deficiencies in airway management could have catastrophic results for the patient. In anaesthesia patients, in particular, a high level of safety should be expected. It has been proven in other high-risk and complex industrial fields that obtaining very high levels of safety requires special strategies and safety philosophies in order to guarantee long-term low-risk production. The concept of safety culture has invaded many industries, more recently including medicine. Concepts of the high reliability organizations (HROs) are now ready to be adapted to medicine and offer promising improvements in health care. This paper applies some of the HRO principles to airway management and illustrates how to transform more general strategies to practical application in the clinical world. This includes the use of key elements of crisis resource management (CRM) and the development of a checklist for safety in airway management.
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Affiliation(s)
- Marcus Rall
- Centre for Patient Safety and Simulation (TuPASS), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Germany.
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Tripi PA, Kandil ES, Arnold JE. Anesthetic management for laser excision of recurrent respiratory papillomatosis in a third trimester parturient. J Clin Anesth 2005; 17:610-3. [PMID: 16427531 DOI: 10.1016/j.jclinane.2005.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Accepted: 01/26/2005] [Indexed: 11/24/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is characterized by the development of laryngeal papillomas, which can produce partial to complete upper airway obstruction. Patients with RRP often require intermittent surgical excision to treat symptoms such as hoarseness and stridor, and to control progression of the lesions. The anesthetic management of such patients is challenging, and it requires carefully coordinated care between an anesthesiologist and otolaryngologist. We present 2 cases of general anesthesia administration during surgical excision of laryngeal papillomas, both occurring during the third trimester of separate pregnancies in the same parturient. The complexity of management was amplified in these cases because of the physiological and anatomical changes associated with pregnancy, along with the need to monitor fetal well-being. Possible complications included complete airway obstruction, pulmonary aspiration of gastric contents, hypoxemia, fetal distress, and preterm labor. Because pregnancy may lead to activation of human papillomavirus, the causative organism of RRP, management guidelines are provided for anesthesiologists who may care for patients with RRP during pregnancy.
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Affiliation(s)
- Paul A Tripi
- Department of Anesthesiology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, LKSD 2500, Cleveland, OH 44106-5007, USA.
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Abstract
OBJECTIVES To provide a current review of the literature regarding airway problems in pregnancy and management. BACKGROUND Obstetrical anesthesia is considered to be a high-risk practice that exposes the anesthesiologist to increased medicolegal liability. Anesthetic management of a parturient is a challenge because it involves simultaneous care of both mother and baby. Failure to appropriately manage a difficult or failed intubation increases the risk of hypoxemic cardiopulmonary arrest and/or pulmonary aspiration, resulting in a high probability of maternal morbidity and mortality. DATA Anesthesia is the seventh leading cause of maternal mortality in the United States. Anatomic and physiologic changes during pregnancy place the parturient at increased risk for airway management problems. It is essential to perform a thorough preanesthetic evaluation and identify the factors predictive of difficult intubation. Airway devices such as the laryngeal mask airway, ProSeal, intubating laryngeal mask airway, Combitube, and laryngeal tube are described and have been used during failed intubation in pregnant patients. CONCLUSION Teamwork between an anesthesiologist and an obstetrician is absolutely essential for the safety of both the mother and baby. Most of us tend to agree that airway emergencies have a way of occurring at the worst possible times. It is essential that all anesthesia care practitioners must have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
This case involves cardiac arrest of a 29-week old pregnant African American woman, occurring 2 days after surgical correction of an incarcerated ventral hernia with small bowel obstruction. The patient could not be resuscitated from this arrest. Details of the case are presented, and diagnostic and unique management considerations for this uncommon occurrence are set forth.
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Affiliation(s)
- Carl W Peters
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
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Tsen LC. What’s new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature. Int J Obstet Anesth 2005; 14:126-46. [PMID: 15795148 DOI: 10.1016/j.ijoa.2004.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 12/24/2004] [Indexed: 10/25/2022]
Abstract
THE PREGNANT PATIENT: Age; maternal disease; prophylactic antibiotics; gastroesophageal reflux; obesity; starvation; genotyping; coagulopathy; infection; substance abuse; altered drug responses in pregnancy; physiological changes of pregnancy. THE FETUS: Fetal monitoring; intrauterine surgery. THE NEWBORN: Breastfeeding; maternal infection, fever, and neonatal sepsis evaluation. OBSTETRIC COMPLICATIONS: Embolic phenomena; hemorrhage; preeclampsia; preterm delivery. OBSTETRIC MANAGEMENT: External cephalic version and cervical cerclage; elective cesarean delivery; fetal malpresentation; vaginal birth after cesarean delivery; termination of pregnancy. OBSTETRIC ANESTHESIA: Analgesia for labor and delivery; anesthesia for cesarean delivery; anesthesia for short obstetric operations; complications of anesthesia. MISCELLANEOUS: Consent; ethics; history; labor support; websites/books/leaflets/journal announcements.
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Affiliation(s)
- L C Tsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston MA 02115, USA.
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Kuczkowski KM. Labor analgesia for the parturient with pregnancy-induced hypertension: what does an obstetrician need to know? Arch Gynecol Obstet 2005; 272:214-7. [PMID: 15660264 DOI: 10.1007/s00404-004-0714-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 11/08/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pregnancy-induced hypertension (PIH), also known as preeclampsia, remains one of the leading causes of maternal death worldwide. The term preeclampsia describes the development of hypertension with proteinuria and/or pathologic edema after the 20th week of gestation. The parturient with PIH usually has multiple organ alterations, which may affect the selection of analgesia and anesthesia for labor and delivery. DISCUSSION This article reviews the special concerns posed by PIH, one of the most common medical conditions encountered in pregnancy.
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Affiliation(s)
- Krzysztof M Kuczkowski
- Departments of Anesthesiology and Reproductive Medicine, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8770, USA.
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Kuczkowski KM. Labor analgesia for the parturient with respiratory disease: what does an obstetrician need to know? Arch Gynecol Obstet 2005; 272:160-6. [PMID: 15650837 DOI: 10.1007/s00404-004-0703-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 09/28/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Significant alterations occur in the pulmonary system during pregnancy, which primarily serve to meet the increased oxygen consumption by the growing fetus. When pregnancy is complicated by a respiratory tract disorder such as asthma, cystic fibrosis or tobacco-related respiratory complications the peripartum management (both obstetric and anesthetic) may become challenging. TECHNIQUE Regional anesthesia remains the technique of choice for these parturients because airway manipulation and endotracheal intubation are avoided. CONCLUSION When providing labor analgesia to parturients with asthma, cystic fibrosis, and tobacco-related respiratory disorders every effort should be made to reduce the likelihood of high (thoracic) levels of analgesia and/or anesthesia and subsequent airway compromise.
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Lipman S, Carvalho B, Brock-Utne J. The demise of general anesthesia in obstetrics revisited: prescription for a cure. Int J Obstet Anesth 2005; 14:2-4. [PMID: 15627530 DOI: 10.1016/j.ijoa.2004.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine recent evidence for the management of the difficult airway. RECENT FINDINGS Recent findings still recommend the importance of a predefined, simple strategy for both the anticipated and unanticipated difficult airway. For the former, awake fiberoptic intubation is still the 'gold standard'. For management of the unanticipated difficult airway, the use of the laryngeal mask airway (LMA), intubating laryngeal mask airway (ILMA), the 'gum elastic bougie' and fiber-optics are recommended. If intubation and ventilation fails, cannula or surgical cricothyroidotomy should be an early consideration. SUMMARY This review of algorithms for management of the difficult airway strengthens several generally accepted crucial points. What is always needed is expertise, which one can only get and maintain by daily practice.
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Affiliation(s)
- Thomas Heidegger
- Department of Anaesthesia, Cantonal Hospital, St. Gallen, Switzerland.
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Abstract
Obstetric anesthesia is considered to be a difficult, high-risk practice that exposes the anesthesiologist to increased medicolegal liability. Anesthetic management of parturient patients is a challenge, as it involves simultaneous care of two lives. The anesthesia practitioner has a duty to provide safe anesthetic care, including effective airway management when providing regional or general anesthesia. The potential need to manipulate the airway is perhaps the leading cause of concern among obstetric anesthesiologists.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology, Baylor College of Medicine, 6550 Fannin, Smith Tower, Suite 1003, Houston, TX 77030, USA.
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Kuczkowski KM. Perioperative care of a pregnant trauma victim: a review of anesthetic considerations. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2004. [DOI: 10.1080/22201173.2004.10872347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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