Airway management for cesarean delivery performed under general anesthesia. (February 2017)

• Record Type: Journal Article
• Authors: Rajagopalan, S.; Suresh, M.; Clark, S.L.; Serratos, B.; Chandrasekhar, S.
• Is Part Of: International journal of obstetric anesthesia. Volume 29(2017)
• Page Start: 64
• Page End: 69
• Publication Date: 2017-02
• Subjects: Cesarean delivery -- General anesthesia -- Failed intubation; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2016.10.007
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: The incidence of general anesthesia for cesarean deliveries was approximately 7% Emergent cesarean delivery (57.8%) accounted for majority of the cases. 97% of women were successfully intubated at direct laryngoscopy. The incidence of failed intubation was 1:232 and all were rescued by the LMA. 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.