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Chapter 22 - The Airway in Obstetrics
from Section 2 - Airway Management: Clinical Settings and Subspecialties
- By Wendy H. Teoh, Mary C. Mushambi
Edited by Tim Cook, Michael Seltz Kristensen
Book:

Core Topics in Airway Management

Published online:

03 October 2020

Print publication:

03 December 2020, pp 185-191
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Summary

Airway management and failed intubation in the pregnant woman present unique challenges which differ from the non-pregnant patient. The provision of general anaesthesia in the obstetric population requires additional considerations of the physiological changes in pregnancy, environmental factors and the safe outcome of mother and baby. Appropriate team planning, preparation and performance of rapid sequence induction should be carried out in order to help to reduce adverse airway events. The OAA/DAS guidelines are designed to help to standardise teaching, reduce the incidence of failed intubation and give guidance on further management should failed intubation occur.

Chapter 28 - Airway management in the ICU
from Section 3 - Specialties
- By Andrew R. Bodenham, Abhiram Mallick
Edited by Ian Calder, Adrian Pearce
Book:

Core Topics in Airway Management

Published online:

10 January 2011

Print publication:

16 December 2010, pp 262-273
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Summary

Airway management is more difficult and stressful in obstetrics, and the consequences of difficulty are more serious than in many other areas. Most problems involve general anaesthesia although airway management may be required in regional anaesthesia. One advantage of regional anaesthesia, if not the main one, is the avoidance in most cases of the need for airway support. Apart from the possible contribution of reduced training in airway management and obstetric general anaesthesia, another factor that might lead to a higher reported incidence is that trainees are now taught to declare failure earlier rather than persist with attempts to intubate. The value of a drill in the management of difficult/failed intubation has long been recognised and a modern, simplified version is offered. Care must also be taken with tracheal extubation, especially if there is a risk of laryngeal oedema, perhaps exacerbated by intubation, for example in pre-eclampsia.

Chapter 26 - Airway management in cervical spine disease
from Section 3 - Specialties
- By Ian Calder
Edited by Ian Calder, Adrian Pearce
Book:

Core Topics in Airway Management

Published online:

10 January 2011

Print publication:

16 December 2010, pp 244-254
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Summary

The pulmonary aspiration of gastric contents can cause a pneumonitis with bronchospasm and pulmonary oedema if acidic liquid is inhaled, or less often airway obstruction or massive atelectasis if particulate matter is inhaled. Cricoid pressure can cause problems with the airway. It is important that cricoid pressure is released or adjusted to become Optimal External Laryngeal Pressure (OELP) if intubation is difficult as this may improve the view at laryngoscopy. The three-finger technique to apply cricoid pressure described by Sellick is actually almost impossible to apply when the patient's head is resting on a pillow. The incidence of regurgitation is not known following intravenous induction of anaesthesia with muscle relaxants, without cricoid pressure applied in patients at high risk. During a rapid sequence induction, intubation has failed after two unsuccessful attempts at laryngoscopy both using the gum elastic bougie.