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Chan J, Chan C, Chia P, Goy R, Sng BL. Novice learners' perspectives on obstetric airway crisis decision-making training using virtual reality simulation. Int J Obstet Anesth 2024; 57:103926. [PMID: 37866972 DOI: 10.1016/j.ijoa.2023.103926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Current training on managing an obstetric difficult airway crisis is likely inadequate, as real-life opportunities to practice are rare. Frequent simulation training sessions could be helpful but are resource intensive. Virtual reality (VR) simulation training may be a potential tool to complement existing simulation curricula. METHODS In this pilot qualitative study, a VR simulation scenario of an obstetric airway crisis was designed to test the decision-making of novice learners rotating through obstetric anesthesia training. Individual interviews were conducted pre-VR to assess learning needs and post-VR to assess perspectives on utilizing the VR teaching tool. The interviews were transcribed and thematically analyzed. RESULTS Twenty-one residents were recruited and participated in the study. Analysis of pre-VR interviews identified three major themes, including gaps in the current curriculum, lack of confidence in managing obstetric difficult airway crises, and recognition that simulation is resource intensive. Post-VR interview themes revealed that VR could be helpful in learning decision-making under stress. Suggested improvements included better video and audio quality, and adding haptic feedback and potential multiplayer features in the future. CONCLUSION We identified the advantages of VR simulation and its potential as an intervention to address gaps in our curriculum. Areas of improvement were identified for more effective future implementation.
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Affiliation(s)
- J Chan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - C Chan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - P Chia
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - R Goy
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - B L Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
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Lechat T, d'Aprigny T, Henriot J, Arthur J, Sylla D, Bénard A, Nouette-Gaulain K. Quick Epidural Top-up with Alkalinized Lidocaine for emergent caesarean delivery (QETAL study): protocol for a randomized, controlled, bicentric trial. Trials 2023; 24:341. [PMID: 37208675 DOI: 10.1186/s13063-023-07366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND General anesthesia in pregnant women can be associated with significant maternal and fetal morbidity. Emergency caesarean section can be performed by converting labor epidural analgesia to surgical anesthesia by injecting high-dose short-acting local anesthetics through the epidural catheter. The effectiveness and the delay to obtain surgical anesthesia depends upon the protocol used. Data indicate that alkalinization of local anesthetics may shorten their onset of action and increase their effectiveness. This study investigates whether alkalinization of adrenalized lidocaine could increase the efficacy and decrease the delay of onset of surgical anesthesia via an indwelling epidural catheter, thus decreasing the necessity to resort to general anesthesia for emergency caesarean deliveries. METHODS This study will be a bicentric, double-blind, randomized, controlled trial with two parallel groups of 66 women who require emergency caesarian deliveries and who have been receiving epidural labor analgesia. The number of subjects in groups will be unbalanced with a 2:1 ratio of experimental:control. In both groups, all eligible patients will have had an epidural catheter placed for labor analgesia with levobupicaine or ropivacaine. Patient randomization will occur when the decision is made by the surgeon that an emergency caesarean delivery is indicated. Surgical anesthesia will be obtained by injecting 20 mL of 2% lidocaine with epinephrine 1:200,000, or 10 mL 2% lidocaine with epinephrine 1:200,000 plus 2 mL sodium bicarbonate 4.2% (total of 12 mL). The primary outcome will be the rate of conversion to general anesthesia for failure of the epidural to provide adequate analgesia. This study will be powered to detect a 50% reduction in the incidence of general anesthesia, from 80 to 40%, with a confidence ratio of 90%. DISCUSSION Sodium bicarbonate could be used to avoid general anesthesia for emergency caesarean deliveries by providing reliable and effective surgical anesthesia in women with pre-existing labor epidural catheters is promising. This randomized controlled trial seeks to determine the optimal local anesthetic mixture for converting epidural analgesia to surgical anesthesia for emergency caesarean sections. This may decrease the need for general anesthesia for emergency caesarian section, shorten the time to fetal extraction, and improve safety and patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT05313256. Registered on 6 April 2022.
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Affiliation(s)
- Thomas Lechat
- Department of Gynecological and Obstetrical Anesthesiology, Bordeaux University Hospital, Bordeaux, France
| | - Thomas d'Aprigny
- Department of Anesthesiology, Bordeaux University Hospital, Bordeaux, France.
| | - Jérémy Henriot
- Department of Anesthesiology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Jill Arthur
- Department of Anesthesiology, Bordeaux University Hospital, Bordeaux, France
| | - Dienabou Sylla
- Department of Clinical Epidemiology, Bordeaux University Hospital, Bordeaux, France
| | - Antoine Bénard
- Department of Clinical Epidemiology, Bordeaux University Hospital, Bordeaux, France
| | - Karine Nouette-Gaulain
- Department of Gynecological and Obstetrical Anesthesiology, Bordeaux University Hospital, Bordeaux, France
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Vajanthri SY, Mohammed S, Kumar M, Chhabra S, Bhatia P, Kamal M, Paliwal B. Evaluation of ultrasound airway assessment parameters in pregnant patients and their comparison with that of non-pregnant women: a prospective cohort study. Int J Obstet Anesth 2023; 53:103623. [PMID: 36682134 DOI: 10.1016/j.ijoa.2022.103623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/09/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical airway assessment parameters differ significantly between pregnant and non-pregnant patients, however literature comparing their ultrasound (US) airway parameters is limited. We planned a prospective cohort study to compare US-assessed airway parameters between pregnant and non-pregnant women. METHODS We enrolled 82 pregnant females scheduled for elective cesarean section under neuraxial anesthesia and 80 age-matched non-pregnant females scheduled for elective surgery. Pre-operative clinical airway assessment was performed in both groups. The US airway assessment was done pre-operatively in non-pregnant and postoperatively in pregnant patients. Our primary objective was to compare US-assessed parameters, and secondary objectives included a comparison of clinical airway assessment parameters and investigating a relationship between a difficult airway (defined as a modified Mallampati grade (MMG) ≥ 3) and other airway assessment parameters. RESULTS Among several US airway parameters, pregnant patients had significantly higher hyomental distance, anterior neck soft tissue thickness at the hyoid and vocal cord level, and oral cavity height, while the tongue thickness and mandibular condylar movements were significantly lower than in non-pregnant patients. Similarly, for the clinical airway assessment, pregnant patients had significantly higher MMG and upper lip bite test scores, mentohyoid distance, and neck circumference. Pregnancy, the ratio of pre-epiglottic space and epiglottis-to-vocal cords distance (Pre-E/E-VC), and hyoid bone visibility were independent predictors of a difficult airway. CONCLUSION The US airway assessment parameters differ significantly between pregnant and non-pregnant patients. Pregnancy, hyoid bone visibility, and Pre-E/E-VC ratio were independent predictors of the difficult airway in female patients.
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Affiliation(s)
- S Y Vajanthri
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - S Mohammed
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India.
| | - M Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - S Chhabra
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India
| | - P Bhatia
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India
| | - M Kamal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India
| | - B Paliwal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India
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O'Sullivan M, Gaffney S, Free R, Smith S. Simulating high-fidelity emergency front-of-neck access: Training in an obstetric setting. Saudi J Anaesth 2023; 17:12-17. [PMID: 37032668 PMCID: PMC10077770 DOI: 10.4103/sja.sja_494_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In a cannot intubate, cannot oxygenate scenario (CICO), emergency front of neck access (eFONA) is the final lifesaving step in airway management to reverse hypoxia and prevent progression to brain injury, cardiac arrest and death. The Difficult Airway Society (DAS) guidelines advise the scalpel cricothyroidotomy method for eFONA. Anatomical and physiological changes in pregnancy exacerbate the already challenging obstetric airway. We aim to assess the impact made by introducing formal eFONA training to the perioperative medicine department of an obstetric hospital. Methods Ethical approval and written informed consent were obtained. 17 anesthetists participated, (two consultants, one senior registrar, four registrars and eight senior house officers). Study design was as follows: Initial participant survey and performance of a timed scalpel cricothyroidotomy on Limbs & Things AirSim Advance X cricothyroidotomy training mannikin. Difficulty of the attempt was rated on a Visual Analogue Scale (VAS). Participants then watched the DAS eFONA training video. They then re-performed a scalpel cricothyroidotomy and completed a repeat survey. The primary endpoint was duration of cricothyroidotomy attempt, measured as time from CICO declaration to lung inflation confirmed visually. After a three-month period, participants were reassessed. Results Four anesthetists had previous eFONA training with simulation, only one underwent training in the previous year. The mean time-to-lung inflation pre-intervention was 123.6 seconds and post-intervention was 80.8 seconds. This was statistically significant (p = 0.0192). All participants found training beneficial. Mean improvement of VAS was 3. All participants' confidence levels in identifying when to perform eFONA and ability to correctly identify anatomy improved. On repeat assessment, 11/13 participants successfully performed a surgical cricothyroidotomy, mean improvement from first attempt was 12 seconds (p = 0.68) which was not statistically significant. Conclusion This method of training is an easily reproducible way to teach a rarely performed skill in the obstetric population.
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Affiliation(s)
| | | | - Ross Free
- Coombe Womens and Infants University Hospital, Dublin, Ireland
| | - Stephen Smith
- Coombe Womens and Infants University Hospital, Dublin, Ireland
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Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. Anesthesiology 2022; 136:697-708. [PMID: 35188971 DOI: 10.1097/aln.0000000000004173] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Estimates for the incidence of difficult intubation in the obstetric population vary widely, though prior studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this study were to provide a contemporary estimate of the frequency of difficult and failed intubation in women undergoing general anesthesia for cesarean delivery and to elucidate risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery. METHODS This is a multicenter, retrospective cohort study utilizing the Multicenter Perioperative Outcomes Group database. The study population included women aged 15-44 undergoing general anesthesia for cesarean delivery between 2004 and 2019 at one of 45 medical centers. Co-primary outcomes included the frequencies of difficult and failed intubation. Difficult intubation was defined as Cormack-Lehane view ≥3, intubation attempts ≥3, rescue fiberoptic intubation, rescue supraglottic airway, or surgical airway. Failed intubation was defined as any attempt at intubation without successful endotracheal tube placement. Rates of difficult and failed intubation were assessed. Several patient demographic, anatomical, and obstetric factors were evaluated for potential associations with difficult intubation. RESULTS We identified 14,748 cases of cesarean delivery performed under general anesthesia. There were 295 cases of difficult intubation, with a frequency of 1:49 (95% CI: 1:55, 1:44) (n=14,531). There were 18 cases of failed intubation, with a frequency of 1:808 (95% CI: 1:1,276, 1:511) (n=14,537). Factors with the highest point estimates for the odds of difficult intubation included increased body mass index, Mallampati score III or IV, small hyoid to mentum distance, limited jaw protrusion, limited mouth opening, and cervical spine limitations. CONCLUSIONS In this large, multi-center, contemporary study of over 14,000 general anesthetics for cesarean delivery, we observed an overall risk of difficult intubation of 1:49 and a risk of failed intubation of 1:808. Most risk factors for difficult intubation were non-obstetric in nature. These data demonstrate that difficult intubation in obstetrics remains an ongoing concern.
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Baghirzada L, Archer D, Walker A, Balki M. Anesthesia-related adverse events in obstetric patients: a population-based study in Canada. Can J Anaesth 2021; 69:72-85. [PMID: 34494224 DOI: 10.1007/s12630-021-02101-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anesthesia-related complications in obstetric patients could be catastrophic and impact the lives of both the parturient and the neonate. The objective of this study was to determine the frequency, temporal trend, and risk factors of anesthesia-related adverse events during hospitalization for delivery in Canada. METHODS This retrospective population-based study utilized the hospitalization database of the Canadian Institute for Health Information for all parturients (gestation ≥ 20 weeks) in Canada (except Quebec) hospitalized for childbirth from April 2004 to March 2017. Complications were identified by the enhanced Canadian version of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems codes. Data were summarized with descriptive statistics. Associations between hospitalizations with an anesthesia-related adverse event and patient characteristics, delivery method, and modality of anesthesia were assessed using multivariate logistic regression. RESULTS Among 2,601,034 hospitalizations (3,194,875 interventions), 8,361 anesthesia-related adverse events occurred over a 13-year period (262 per 100,000 interventions; 95% confidence interval [CI], 256 to 267), with a significant decline over time (P < 0.001). These were two-fold and seven-fold higher per 100,000 interventions with general (488; 95% CI, 438 to 542) and general plus neuraxial (1,476; 95% CI, 1,284 to 1,689) anesthesia compared with neuraxial anesthesia alone (225; 95% CI, 219 to 230). Serious adverse events constituted 9% of all adverse events. The most common adverse event was spinal and epidural anesthesia-induced headache (6,908/8,361; 83%); the overall rate of failed or difficult intubations was low (201/8,361; 2%). Anesthesia-related events were more likely in those who had a Cesarean delivery compared with vaginal delivery (odds ratio [OR], 1.12; 95% CI, 1.06 to 1.18) and general anesthesia compared with neuraxial anesthesia (OR, 1.71; 95% CI, 1.53 to 1.93). Noteworthy associations were found between any anesthesia-related adverse events and cardiomyopathy (OR, 8.34; 95% CI, 2.59 to 26.83), eclampsia (OR, 3.11; 95% CI, 1.95 to 4.97), and obstructive sleep apnea (OR, 1.91; 95% CI, 1.66 to 2.19). CONCLUSION The incidence of anesthesia-related adverse events in obstetric patients in Canada is low and declining. High vigilance is required in parturients undergoing Cesarean delivery, receiving general anesthesia, and those with pre-existing medical conditions.
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Affiliation(s)
- Leyla Baghirzada
- Department of Anesthesiology, Perioperative and Pain Medicine, South Health Campus, University of Calgary, 4448 Front St SE, Calgary, AB, T3M 1M4, Canada.
| | - David Archer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew Walker
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Mrinalini Balki
- Department of Anesthesia and Obstetrics & Gynaecology, University of Toronto, Mount Sinai Hospital, The Lunenfeld-Tanenbaum Research Institute, Sinai Health System, TorontoToronto, ON, Canada
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Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Jones PM, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Kovacs G. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth 2021; 68:1373-1404. [PMID: 34143394 PMCID: PMC8212585 DOI: 10.1007/s12630-021-02007-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider "exit strategy" options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a "cannot ventilate, cannot oxygenate" emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as "airway lead" to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.
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Affiliation(s)
- J. Adam Law
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Room 5452, Halifax, NS B3H 3A7 Canada
| | - Laura V. Duggan
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Mathieu Asselin
- grid.23856.3a0000 0004 1936 8390Département d’anesthésiologie et de soins intensifs, Université Laval, 2325 rue de l’Université, Québec, QC G1V 0A6 Canada ,grid.411081.d0000 0000 9471 1794Département d’anesthésie du CHU de Québec, Hôpital Enfant-Jésus, 1401 18e rue, Québec, QC G1J 1Z4 Canada
| | - Paul Baker
- grid.9654.e0000 0004 0372 3343Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Edward Crosby
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Suite CCW1401, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Andrew Downey
- grid.1055.10000000403978434Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Orlando R. Hung
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Philip M. Jones
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Rd., London, ON N6A 5A5 Canada
| | - François Lemay
- grid.417661.30000 0001 2190 0479Département d’anesthésiologie, CHU de Québec – Université Laval, Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, QC G1R 2J6 Canada
| | - Rudiger Noppens
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Matteo Parotto
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Interdepartmental Division of Critical Care Medicine, University of Toronto, EN 442 200 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Roanne Preston
- grid.413264.60000 0000 9878 6515Department of Anesthesia, BC Women’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Nick Sowers
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Kathryn Sparrow
- grid.25055.370000 0000 9130 6822Discipline of Anesthesia, St. Clare’s Mercy Hospital, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John’s, NL A1B V6 Canada
| | - Timothy P. Turkstra
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - David T. Wong
- grid.17063.330000 0001 2157 2938Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St, Toronto, ON M5T2S8 Canada
| | - George Kovacs
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
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Wladarz J, Wenk M, Massoth C. Notsectio: eine Herausforderung in der geburtshilflichen Anästhesie. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:662-673. [PMID: 33242900 DOI: 10.1055/a-1070-6810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lim MJ, Tan HS, Tan CW, Li SY, Yao WY, Yuan YJ, Sultana R, Sng BL. The effects of labor on airway outcomes with Supreme™ laryngeal mask in women undergoing cesarean delivery under general anesthesia: a cohort study. BMC Anesthesiol 2020; 20:213. [PMID: 32847548 PMCID: PMC7449044 DOI: 10.1186/s12871-020-01132-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pregnancy is associated with higher incidence of failed endotracheal intubation and is exacerbated by labor. However, the influence of labor on airway outcomes with laryngeal mask airway (LMA) for cesarean delivery is unknown. METHODS This is a secondary analysis of a prospective cohort study on LMA use during cesarean delivery. Healthy parturients who fasted > 4 h undergoing Category 2 or 3 cesarean delivery with Supreme™ LMA (sLMA) under general anesthesia were included. We excluded parturients with BMI > 35 kg/m2, gastroesophageal reflux disease, or potentially difficult airway (Mallampati score of 4, upper respiratory tract or neck pathology). Anesthesia and airway management reflected clinical standard at the study center. After rapid sequence induction and cricoid pressure, sLMA was inserted as per manufacturer's recommendations. Our primary outcome was time to effective ventilation (time from when sLMA was picked up until appearance of end-tidal carbon dioxide capnography), and secondary outcomes include first-attempt insertion failure, oxygen saturation, ventilation parameters, mucosal trauma, pulmonary aspiration, and Apgar scores. Differences between labor status were tested using Student's t-test, Mann-Whitney U test, or Fisher's exact test, as appropriate. Quantitative associations between labor status and outcomes were determined using univariate logistic regression analysis. RESULTS Data from 584 parturients were analyzed, with 37.8% in labor. Labor did not significantly affect time to effective ventilation (mean (SD) for labor: 16.0 (5.75) seconds; no labor: 15.3 (3.35); mean difference: -0.65 (95%CI: - 1.49 to 0.18); p = 0.1262). However, labor was associated with increased first-attempt insertion failure and blood on sLMA surface. No reduction in oxygen saturation or pulmonary aspiration was noted. CONCLUSIONS Although no significant increase in time to effective ventilation was noted, labor may increase the number of insertion attempts and oropharyngeal trauma with sLMA use for cesarean delivery in parturients at low risk of difficult airway. Future studies should investigate the effects of labor on LMA use in high risk parturients. TRIAL REGISTRATION The study was prospectively registered at clinicaltrials.gov ( NCT02026882 ) on 3 January 2014.
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Affiliation(s)
- Ming Jian Lim
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Shi Yang Li
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Wei Yu Yao
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Yong Jing Yuan
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai Province, China
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Richardson MG, Raymond BL. Sugammadex Administration in Pregnant Women and in Women of Reproductive Potential. Anesth Analg 2020; 130:1628-1637. [DOI: 10.1213/ane.0000000000004305] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bonnet MP, Mercier FJ, Vicaut E, Galand A, Keita H, Baillard C. Incidence and risk factors for maternal hypoxaemia during induction of general anaesthesia for non-elective Caesarean section: a prospective multicentre study. Br J Anaesth 2020; 125:e81-e87. [PMID: 32303378 DOI: 10.1016/j.bja.2020.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pregnant women are at increased risk of hypoxaemia during general anaesthesia. Our aim was to determine the incidence and the risk factors that contribute to hypoxaemia in this setting. METHODS Every woman 18 yr or older who underwent a non-elective Caesarean section under general anaesthesia was eligible to participate in this multicentre observational study. The primary endpoint was the incidence of hypoxaemia defined as the SpO2 ≤95%. The secondary endpoint was the incidence of difficult intubation defined as more than two attempts or failed intubation. RESULTS During the study period, 895 women were prospectively included in 17 maternity hospitals, accounting for 79% of women who had general anaesthesia for non-elective Caesarean section. Maternal hypoxaemia was observed in 172 women (19%; confidence interval [CI], 17-22%). Risk factors associated with hypoxaemia in the multivariate analysis were difficult or failed intubation (adjusted odds ratio [aOR]=19.1 [8.6-42.7], P<0.0001) and BMI >35 kg m-2 (aOR=0.53 [0.28-0.998], P=0.0495). Intubation was difficult in 40 women (4.5%; CI, 3.3-6%) and failed intubation occurred in five women (0.56%; CI, 0.1-1%). In the multivariate analysis, use of a hypnotic drug other than propofol was associated with difficult or failed intubation (aOR=25 [2-391], P=0.02). A propensity score confirmed that propofol was associated with a significant decreased risk of difficulty or failure to intubate (P<0.001). CONCLUSIONS Hypoxaemia during Caesarean sections was observed in 19% of women and was significantly associated with difficult or failed intubation. The use of propofol may protect against the occurrence of difficult intubation.
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Affiliation(s)
- Marie-Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric J Mercier
- Department of Anaesthesiology, Antoine Béclère University Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Lariboisière University Hospital, Paris 7 Diderot University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Galand
- Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hawa Keita
- Department of Anaesthesiology and Critical Care, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Unité de Recherche EA 7323 Pharmacologie et Evaluation des Thérapeutiques hez l'Enfant et la Femme Enceinte, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Chan JJ, Goy RW, Ithnin F, Sng BL. Difficult obstetric airway training: Current strategies, challenges and future innovations. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong P, Sng BL, Lim WY. Rescue supraglottic airway devices at caesarean delivery: What are the options to consider? Int J Obstet Anesth 2019; 42:65-75. [PMID: 31843342 DOI: 10.1016/j.ijoa.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. Failed intubation is associated with a further increased risk of aspiration, therefore there is an argument for performing supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric population, it protects the airway and it minimises task fixation on repeated attempts at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation. Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.
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Affiliation(s)
- P Wong
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore.
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's & Children's Hospital, Singapore
| | - W Y Lim
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore
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Tan HS, Li SY, Yao WY, Yuan YJ, Sultana R, Han NLR, Sia ATH, Sng BL. Association of Mallampati scoring on airway outcomes in women undergoing general anesthesia with Supreme™ laryngeal mask airway in cesarean section. BMC Anesthesiol 2019; 19:122. [PMID: 31286890 PMCID: PMC6615162 DOI: 10.1186/s12871-019-0796-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics. Methods This prospective cohort study was performed at a single-center: Quanzhou Women’s and Children’s Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes. Results The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p < 0.0001). There was no difference in maternal age, ASA status and gestational age. There was similar time to effective ventilation (mean (SD) High MP: 14.9 (4.5) vs Low MP: 15.7 (4.4) seconds, p = 0.2172), and first attempt success rate, seal pressure, and peak airway pressure. No clinical aspiration was noted. The incidence of blood on SLMA was higher in the High MP group than in Low MP (4 (6.6%) vs 4 (0.8%), p = 0.001). There was no difference in sore throat, voice hoarseness, maternal satisfaction and fetal outcomes. Conclusion High MP was not associated with reduced SLMA airway outcomes in cesarean section under general anesthesia, but may increase the risk of blood found on SLMA upon removal. Trial registration This study was registered at http://www.clinicaltrials.gov, identifier: NCT02026882, retrospectively registered. Date of registration: December 31, 2013.
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Affiliation(s)
- Hon Sen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Shi Yang Li
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Wei Yu Yao
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Yong Jing Yuan
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghar Province, China
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Nian-Lin R Han
- Division of Clinical Support Services, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Alex Tiong Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore. .,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore.
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Yao WY, Li SY, Yuan YJ, Tan HS, Han NLR, Sultana R, Assam PN, Sia ATH, Sng BL. Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial. BMC Anesthesiol 2019; 19:123. [PMID: 31286883 PMCID: PMC6615212 DOI: 10.1186/s12871-019-0792-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section. Methods Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, fetal outcomes, and maternal side effects associated with the airway device. Results We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective cesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--ORSLMA/ETT: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: − 23.71, − 22.21 s) compared to ETT group (p < 0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration. Conclusions SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second-line use of LMA in the management of the obstetric airway. Trial registration The study was registered at http://www.clinicaltrials.gov, identifier: NCT01858467, retrospectively registered. Date of registration: May 21, 2013.
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Affiliation(s)
- Wei Yu Yao
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Shi Yang Li
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Yong Jin Yuan
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai Province, China
| | - Hon Sen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Nian-Lin R Han
- Division of Clinical Support Services, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Pryseley N Assam
- Singapore Clinical Research Institute, 31 Biopolis Way, Singapore, Singapore
| | - Alex Tiong-Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore. .,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore.
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Theoretical optimal cricothyroidotomy incision length in female subjects, following identification of the cricothyroid membrane by digital palpation. Int J Obstet Anesth 2018; 36:42-48. [DOI: 10.1016/j.ijoa.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
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Popovici SE, Mitre C. Difficult airway management - a constant challenge. Rom J Anaesth Intensive Care 2018; 25:93-94. [PMID: 30393763 PMCID: PMC6211614 DOI: 10.21454/rjaic.7518.252.pop] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sonia-Elena Popovici
- Anaesthesia and Intensive Care Department, "Pius Branzeu" Emergency County Hospital, Timşoara, Romania
| | - Călin Mitre
- Anaesthesia and Intensive Care Department 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Failed airway management in the obstetric patient undergoing general anaesthesia is associated with major sequelae for the mother and/or fetus. Effective and adequate pre-oxygenation is an important safety strategy and a recommendation in all current major airway guidelines. Pre-oxygenation practice in the obstetric population may be suboptimal based on current literature. Recently, clinical applications for high flow nasal oxygen, also known as transnasal humidified rapid insufflation ventilatory exchange or THRIVE, are expanding in the non-obstetric population and may have theoretical benefits if used for pre-oxygenation and apnoeic oxygenation in the obstetric population. We review the current literature surrounding high flow nasal oxygen relevant to the pregnant woman. We also propose a basis for potential advantages and complications for its use in this context.
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Affiliation(s)
- P. C. F. Tan
- Royal Melbourne Hospital and Honorary Anaesthetics Research Fellow, Royal Women's Hospital, Melbourne, Victoria
| | - A. T. Dennis
- Director of Anaesthesia Research, Department of Anaesthesia, The Royal Women's Hospital and NHMRC Fellow, University of Melbourne, Departments of Pharmacology and Obstetrics and Gynaecology, Melbourne, Victoria
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Shobha D, Adiga M, Rani DD, Kannan S, Nethra SS. Comparison of Upper Lip Bite Test and Ratio of Height to Thyromental Distance with Other Airway Assessment Tests for Predicting Difficult Endotracheal Intubation. Anesth Essays Res 2018; 12:124-129. [PMID: 29628567 PMCID: PMC5872848 DOI: 10.4103/aer.aer_195_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS Unanticipated difficult intubation or the failed intubation in operating room and in emergency department is an imperative source of anesthesia-related patient's mortality. The aim of this study is to compare the predictive value of upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) with other commonly used preoperative airway assessment tests for predicting difficult intubation in Indian population. MATERIALS AND METHODS In this prospective, single-blinded observational study, 260 adult patients of either sex, belonging to American Society of Anesthesiologists physical Status I and II undergoing elective surgical procedure under general anesthesia were included in the study. ULBT, RHTMD, inter-incisor gap, modified Mallampati grade, horizontal length of the mandible, head and neck movements, sternomental distance, and TMD were assessed preoperatively and correlated with Cormack and Lehane's grading during laryngoscopy under anesthesia. Statistical analysis was done by Chi-square and Fisher's exact test. RESULTS ULBT and RHTMD had highest sensitivity (66.7% and 63.3%), specificity (99.1% and 89.6%), positive predictive value (90.9% and 44.2%), and negative predictive value (96.9% and 95.0%), respectively, when compared to other parameters in predicting difficult airway. CONCLUSION ULBT and RHTMD may be used as a simple bedside airway assessment tools for prediction of difficult intubation.
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Affiliation(s)
- D. Shobha
- Department of Anesthesiology, Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Maitri Adiga
- Department of Anesthesiology, Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - D. Devika Rani
- Department of Anesthesiology, Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sudheesh Kannan
- Department of Anesthesiology, Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - S. S. Nethra
- Department of Anesthesiology, Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
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Supreme™ laryngeal mask airway use in general Anesthesia for category 2 and 3 Cesarean delivery: a prospective cohort study. BMC Anesthesiol 2017; 17:169. [PMID: 29258438 PMCID: PMC5735892 DOI: 10.1186/s12871-017-0460-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022] Open
Abstract
Background The Supreme™ laryngeal mask airway (SLMA) is a single-use LMA with double lumen design that allows separation of the respiratory and the alimentary tract, hence potentially reducing the gastric volume and risk of aspiration. The purpose of this prospective cohort study is to evaluate the the role of the SLMA as an airway technique for women undergoing category 2 and 3 Cesarean delivery under general anesthesia. Methods We recruited 584 parturients who underwent category 2 or 3 Cesarean delivery under general anesthesia, in which 193 parturients underwent category 2 and 391 parturients underwent category 3 Cesarean delivery. The primary outcome was insertion success rate at 1st attempt in SLMA insertion. The secondary outcomes included anaesthetic, obstetric outcomes and maternal side effects associated with airway device. Results The 1st attempt insertion success rate was 98.3%, while the overall insertion success rate was 100%. The mean (Standard deviation) time to effective ventilation was 15.6 (4.4) seconds. Orogastric tube insertion was successful at the 1st attempt in all parturients. There was no clinical evidence of aspiration or regurgitation. No episodes of hypoxemia, laryngospasm or bronchospasm were observed intra-operatively. The incidence of complications was low and with good maternal satisfaction reported. Conclusions The SLMA could be an alternative effective airway in category 2 and 3 parturients emergency Cesarean Delivery under general anesthesia in a carefully-selected obstetric population. Trial registration Clinical Trials Registration: Clinicaltrials.gov Registration NCT02026882. Registered on December 31, 2013.
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Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia 2017; 73:93-111. [DOI: 10.1111/anae.14123] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
- T. M. Cook
- Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
- School of Clinical Sciences; Bristol University; Bristol UK
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McNarry A, Patel A. The evolution of airway management – new concepts and conflicts with traditional practice. Br J Anaesth 2017; 119:i154-i166. [DOI: 10.1093/bja/aex385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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McKenzie C, Akdagli S, Abir G, Carvalho B. Postpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions. J Clin Anesth 2017; 43:39-46. [PMID: 28985581 DOI: 10.1016/j.jclinane.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/02/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE The primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL. DESIGN An institutional-specific retrospective review of patients with ICD-9 procedure codes for PPTL over a 2-year period was conducted. Obstetric anesthesia fellowship directors were surveyed on anesthetic management of PPTL. SETTING Labor and delivery unit. Internet survey. PATIENTS 202 PPTL procedures were reviewed. 47 institutions were surveyed; 26 responses were received. MEASUREMENTS Timing of PPTL, anesthetic management, postoperative pain and length of stay. MAIN RESULTS There was an epidural catheter reactivation failure rate of 26% (18/69 epidural catheter reactivation attempts). Time from epidural catheter insertion to PPTL was a significant factor associated with failure: median [IQR; range] time for successful versus failed epidural catheter reactivation was 17h [10-25; 3-55] and 28h [14-33; 5-42], respectively (P=0.028). Epidural catheter reactivation failure led to significantly longer times to provide surgical anesthesia than successful epidural catheter reactivation or primary spinal technique: median [IQR] 41min [33-54] versus 15min [12-21] and 19min [15-24], respectively (P<0.0001). Fifty-eight percent (15/26) of respondents routinely leave the labor epidural catheter in-situ if PPTL is planned. Sixty-five percent (17/26) and 7% (2/26) would not attempt to reactivate the epidural catheter for PPTL if >8h and >24h post-delivery, respectively. CONCLUSIONS Epidural catheter reactivation failure increases with longer intervals between catheter placement and PPTL. Failed epidural catheter reactivation increases anesthetic and operating room times. Our results and the significant variability in practice from our survey suggest recommendations on the timing and anesthetic management are needed to reduce unfulfilled PPTL procedures.
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Affiliation(s)
- Christine McKenzie
- Department of Anesthesiology, UNC Medical Center, 101 Manning Drive, Chapel Hill, NC 27516, United States
| | - Seden Akdagli
- Department of Anesthesiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Gillian Abir
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States.
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Baruah P, Jasraj K, Ahmad I. Principles of ear nose and throat surgery for pregnant women. Br J Hosp Med (Lond) 2017; 78:206-212. [PMID: 28398899 DOI: 10.12968/hmed.2017.78.4.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of the pregnant surgical patient is challenging. The surgical procedure is usually postponed until the postpartum period, although this may not be possible in emergency situations. This article highlights the optimal management of the pregnant woman requiring ear nose and throat surgery.
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Affiliation(s)
- Paramita Baruah
- ST8 in Ear Nose and Throat Surgery, Department of Ear Nose and Throat, Heartlands Hospital, Birmingham B9 5SS
| | - Kailey Jasraj
- Consultant, Department of Anaesthesia, Heartlands Hospital, Birmingham
| | - Ijaz Ahmad
- Consultant, Department of Ear Nose and Throat Surgery, Heartlands Hospital, Birmingham
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Yıldırım İ, İnal MT, Memiş D, Turan FN. Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section. Balkan Med J 2017; 34:436-443. [PMID: 28443579 PMCID: PMC5635631 DOI: 10.4274/balkanmedj.2016.0877] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients’ ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women.
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Affiliation(s)
- İlker Yıldırım
- Clinic of Anesthesiology, Uzunköprü Public Hospital, Edirne, Turkey
| | - Mehmet Turan İnal
- Department of Anesthesiology and Reanimation, Trakya University School of Medicine, Edirne, Turkey
| | - Dilek Memiş
- Department of Anesthesiology and Reanimation, Trakya University School of Medicine, Edirne, Turkey
| | - F Nesrin Turan
- Department of Biostatistics, Trakya University School of Medicine, Edirne, Turkey
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Cook T, Kelly F. A national survey of videolaryngoscopy in the United Kingdom. Br J Anaesth 2017; 118:593-600. [DOI: 10.1093/bja/aex052] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 01/28/2023] Open
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Krom AJ, Cohen Y, Miller JP, Ezri T, Halpern SH, Ginosar Y. Choice of anaesthesia for category-1 caesarean section in women with anticipated difficult tracheal intubation: the use of decision analysis. Anaesthesia 2016; 72:156-171. [DOI: 10.1111/anae.13729] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- A. J. Krom
- Department of Anesthesiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Y. Cohen
- Post-Anesthesia Care Unit; Department of Anesthesiology; Chaim Sheba Medical Center; Tel-Hashomer Ramat-Gan Israel
| | - J. P. Miller
- Washington University School of Medicine; St Louis MO USA
| | - T. Ezri
- Department of Anesthesia; Wolfson Medical Center; Holon Israel
- Outcomes Research Consortium; Cleveland OH USA
| | - S. H. Halpern
- Department of Anesthesia; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Canada
| | - Y. Ginosar
- Department of Anesthesiology and Director; Mother and Child Anesthesia Unit; Hadassah Hebrew University Hospital; Jerusalem Israel
- Department of Anesthesiology and Director; Division of Obstetric Anesthesiology; Washington University School of Medicine; St Louis MO USA
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Rajagopalan S, Suresh M, Clark SL, Serratos B, Chandrasekhar S. Airway management for cesarean delivery performed under general anesthesia. Int J Obstet Anesth 2016; 29:64-69. [PMID: 27884665 DOI: 10.1016/j.ijoa.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND With the increasing popularity of neuraxial anesthesia, there has been a decline in the use of general anesthesia for cesarean delivery. We sought to examine the incidence, outcome and characteristics associated with a failed airway in patients undergoing cesarean delivery under general anesthesia. METHODS A retrospective review of airway management in women undergoing cesarean delivery under general anesthesia over an eight-year period from 2006-2013 at an academic medical center was conducted. RESULTS During the study period, 10 077 cesarean deliveries were performed. Neuraxial anesthesia was used in 9382 (93%) women while general anesthesia was used in 695 (7%). Emergent cesarean delivery was the most common indication for general anesthesia. Failed intubation was encountered in only three (0.4%) women, who were successfully managed with a laryngeal mask airway. The overall incidence of failed intubation was 1 in 232 (95% CI 1:83 to 1:666) and general anesthesia was continued in all cases. There were no adverse maternal or fetal outcomes directly related to failed intubation. CONCLUSION Advances in adjunct airway equipment, availability of an experienced anesthesiologist and simulation-based teaching of failed airway management in obstetrics may have contributed to our improved maternal outcomes in patients undergoing cesarean delivery under general anesthesia.
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Affiliation(s)
- S Rajagopalan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
| | - M Suresh
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - S L Clark
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - B Serratos
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - S Chandrasekhar
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
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Patel S, Fernando R. Opioids should be given before cord clamping for caesarean delivery under general anaesthesia. Int J Obstet Anesth 2016; 28:76-80. [PMID: 27720615 DOI: 10.1016/j.ijoa.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- S Patel
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK.
| | - R Fernando
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
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Turnbull J, Patel A, Athanassoglou V, Pandit JJ. Cricoid pressure: apply - but be ready to release. Anaesthesia 2016; 71:999-1003. [DOI: 10.1111/anae.13594] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. Turnbull
- The Royal National Throat, Nose and Ear Hospital; London UK
| | - A. Patel
- The Royal National Throat, Nose and Ear Hospital; London UK
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Pillai A, Chikhani M, Hardman JG. Apnoeic oxygenation in pregnancy: a modelling investigation. Anaesthesia 2016; 71:1077-80. [PMID: 27440389 DOI: 10.1111/anae.13563] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Abstract
Recent studies have shown that nasal oxygen delivery can prolong the time to desaturation during apnoea in the non-pregnant population. We investigated the benefits of apnoeic oxygenation during rapid sequence induction in the obstetric population using computational modelling. We used the Nottingham Physiology Simulator, and pre-oxygenated seven models of pregnancy for 3 min using Fi O2 1.0, before inducing apnoea. We found that increasing Fi O2 at the open glottis increased the time to desaturation, extending the time taken for Sa O2 to reach 40% from 4.5 min to 58 min in the average parturient model (not in labour). Our study suggests that a small increase in time to desaturation could be achieved at Fi O2 0.4-0.6, which could be delivered by standard nasal cannulae. The greatest increases in time to desaturation were seen at Fi O2 1.0, which could be delivered by high-flow nasal cannulae under ideal conditions.
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Affiliation(s)
- A Pillai
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Chikhani
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J G Hardman
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2016; 70:1286-306. [PMID: 26449292 PMCID: PMC4606761 DOI: 10.1111/anae.13260] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/16/2022]
Abstract
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.
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Affiliation(s)
- M C Mushambi
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | - S M Kinsella
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - M Popat
- Nuffield Department of Anaesthesia, Oxford University Hospital NHS Trust, Oxford, UK
| | - H Swales
- Department of Anaesthesia, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - K K Ramaswamy
- Department of Anaesthesia, Northampton General Hospital, Northampton, UK
| | - A L Winton
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - A C Quinn
- Department of Anaesthesia, James Cook University Hospital, Middlesborough, UK.,Leeds University, Leeds, UK
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Kinsella S, Winton A, Mushambi M, Ramaswamy K, Swales H, Quinn A, Popat M. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth 2015; 24:356-74. [DOI: 10.1016/j.ijoa.2015.06.008] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/27/2022]
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Airway management in patients undergoing emergency Cesarean section. J Anesth 2015; 29:927-33. [DOI: 10.1007/s00540-015-2037-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/17/2015] [Indexed: 12/19/2022]
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Heinrich S, Irouschek A, Prottengeier J, Ackermann A, Schmidt J. Adverse airway events in parturient compared with non-parturient patients. Is there a difference? Results from a quality management project. J Obstet Gynaecol Res 2015; 41:1032-9. [PMID: 25772267 DOI: 10.1111/jog.12677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
AIM The fear of airway problems often leads to prolonged attempts to obtain neuroaxial (spinal anesthesia or epidural anesthesia) anesthesia in obstetric anesthesia. The aim of this institutional quality management study was to revisit existing anesthesia care in the obstetric department, focusing on the frequency of delayed or failed neuroaxial anesthesia as well as the risk of airway problems in parturient and non-obstetric patients. METHODS The clinical records from 8 consecutive years (2005-2013) were analyzed retrospectively. Cases of cesarean delivery with general anesthesia were analyzed and compared with an age-matched group of female patients undergoing non-obstetric abdominal or gynecological surgery with rapid sequence induction. Poor laryngeal visualization (Cormack-Lehane grade III or IV) and failed intubation were recorded. RESULTS The records of 6393 cesarean deliveries including 851 with general anesthesia were analyzed. In 175 cases insufficient or delayed onset of regional anesthesia led to requirement for general anesthesia. The rate of poor laryngoscopic view in parturient women undergoing cesarean delivery was 14/851, and 4/814 in the reference group (P = 0.023). Failed intubation occurred in three patients undergoing cesarean delivery (0.4%) and in one non-obstetric patient (0.1%; P = 0.339). CONCLUSION The rate of failed intubations in patients undergoing cesarean delivery may be equivalent to non-obstetric patients. In time-challenging cesarean deliveries, delay of conversion from non-successful neuroaxial anesthesia to general anesthesia in order to avoid adverse airway events does not appear to be justified.
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Affiliation(s)
- Sebastian Heinrich
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Andrea Irouschek
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | | | - Andreas Ackermann
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Schmidt
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
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Liu CW, Sng BL, Farida I. Obstetric anesthesia training: Facilitating teaching and learning. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Effectiveness of using high-fidelity simulation to teach the management of general anesthesia for Cesarean delivery. Can J Anaesth 2014; 61:922-34. [DOI: 10.1007/s12630-014-0209-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022] Open
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40
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Chikkabbaiah V, McCahon R. Speed of spinal vs general anaesthesia. Anaesthesia 2013; 68:976-7. [PMID: 24047359 DOI: 10.1111/anae.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Chikkabbaiah
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
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41
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Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization. ScientificWorldJournal 2013; 2013:695209. [PMID: 23983645 PMCID: PMC3745990 DOI: 10.1155/2013/695209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients.
Methods. One hundred sixty morbidly obese (≥40 kg/m2) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded. Results. Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively. Conclusion. Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone.
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Kathirgamanathan A, Douglas MJ, Tyler J, Saran S, Gunka V, Preston R, Kliffer P. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study. Anaesthesia 2013; 68:753-9. [DOI: 10.1111/anae.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. J. Douglas
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - J. Tyler
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - S. Saran
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - V. Gunka
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - R. Preston
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - P. Kliffer
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
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Löser B, Tank S, Hillebrand G, Goldmann B, Diehl W, Biermann D, Schirmer J, Reuter DA. [Peripartum cardiomyopathy: interdisciplinary challenge]. Anaesthesist 2013; 62:343-54. [PMID: 23584315 DOI: 10.1007/s00101-013-2167-9] [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] [Indexed: 11/28/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare type of heart failure which presents towards the end of pregnancy or in the first 5 months after delivery. Depending on the geographical location the incidence is reported in the literature as 1:300 up to 1:15,000. There are a number of known risk factors, such as multiparity and age of the mother over 30 years. The symptoms of PPCM correspond to those of idiopathic cardiomyopathy. The diagnosis is mainly carried out using echocardiography which shows a clear reduction of systolic left ventricular function. The therapeutic approach is the same as for idiopathic cardiomyopathy and in this context it is absolutely necessary to show caution concerning the state of pregnancy and the resulting contraindications for therapeutic drugs. The prognosis is dependent on recovery from the heart failure during the first 6 months postpartum. The lethality of the disease is high and is given in the literature as up to 28 %. Because of its complexity PPCM is an interdisciplinary challenge. In the peripartum phase a close cooperation between the disciplines of cardiology, cardiac surgery, neonatology, obstetrics and anesthesiology is indispensable. For anesthesiology the most important aspects are the mostly advanced unstable hemodynamic condition of the mother and the planning and implementation of the perioperative management. This article presents the case of a patient in advanced pregnancy with signs of acute severe heart failure and a suspected diagnosis of PPCM. The patient presented as an emergency case and delivery of the child was carried out using peridural anesthesia with a stand-by life support machine.
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Affiliation(s)
- B Löser
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Deutschland.
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Quinn A, Milne D, Columb M, Gorton H, Knight M. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK. Br J Anaesth 2013; 110:74-80. [DOI: 10.1093/bja/aes320] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Parthasarathy S, Bag SK, Krishnaveni N. Assessment of airway the MOUTH concept. J Anaesthesiol Clin Pharmacol 2012; 28:539. [PMID: 23225950 PMCID: PMC3511967 DOI: 10.4103/0970-9185.101958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Parthasarathy
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puduchery, India
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Cook T, MacDougall-Davis S. Complications and failure of airway management. Br J Anaesth 2012; 109 Suppl 1:i68-i85. [DOI: 10.1093/bja/aes393] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Aziz MF, Kim D, Mako J, Hand K, Brambrink AM. A Retrospective Study of the Performance of Video Laryngoscopy in an Obstetric Unit. Anesth Analg 2012; 115:904-6. [DOI: 10.1213/ane.0b013e3182642130] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Beckmann M, Calderbank S. Mode of anaesthetic for category 1 caesarean sections and neonatal outcomes. Aust N Z J Obstet Gynaecol 2012; 52:316-20. [PMID: 22676478 DOI: 10.1111/j.1479-828x.2012.01457.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Birth by emergency caesarean section (CS) is common and often considered urgent (category 1). In the UK, over half of all category 1 CS are performed under general anaesthesia (GA). In this setting, little is known about the effect of the mode of anaesthesia on the neonate. METHODS A retrospective cohort study was performed using routinely collected de-identified data from Mater Health Services, Brisbane, Australia. The data set included 533 term babies born by category 1 CS for presumed fetal compromise between 2008 and 2011. Bivariate and multivariate analyses were undertaken. RESULTS The outcomes of 81 babies born by GA CS were compared with 452 by CS under regional anaesthesia (RA). Compared with a category 1 CS under RA, the decision-to-delivery interval for a GA CS was almost eight minutes faster (24.7 vs 32.6 minutes; P < 0.001). When adjusted for confounders, babies born by category 1 GA CS were significantly more likely to have an Apgar score < 7 at five minutes (aOR 6.89; 95%CI 1.79-26.55; P = 0.005), to require Neopuff or bag/mask ventilation for > 60 seconds (aOR 2.34; 95%CI 1.13-4.84; P = 0.022) and to be admitted to a neonatal intensive care nursery (aOR 2.24; 95%CI 1.16-4.31; P = 0.016). CONCLUSIONS General anaesthesia was associated with short-term neonatal morbidity of term babies born by category 1 CS for presumed fetal compromise, despite enabling a more rapid delivery of the baby. These data should help inform the discussion between anaesthetist and obstetrician, in balancing the risks and benefits of the mode of anaesthesia.
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Affiliation(s)
- Michael Beckmann
- Department of Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia.
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Guirro UBDP, Martins CR, Munechika M. Assessment of Anesthesiologists’ Rapid Sequence Induction Technique in an University Hospital. Braz J Anesthesiol 2012; 62:335-45. [DOI: 10.1016/s0034-7094(12)70134-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022] Open
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