Challenges of airway management in obstetrics

Airway management in obstetrics

Abstract

Background and purpose: Pregnant individuals exhibit a lower tolerance for apnea due to heightened metabolic oxygen consumption coupled with a gradual reduction in functional residual capacity (FRC). In obstetric patients, anesthesia-related mortality is frequently attributed to respiratory complications. It is advisable to assess the airway of each patient upon their admission to the labor floor. Should we anticipate challenges in airway management, it is prudent to implement neuraxial analgesia, such as an epidural catheter, as early as possible to mitigate the necessity for general anesthesia and airway management during cesarean delivery if required. Neuraxial anesthesia is predominantly utilized for cesarean deliveries, even in emergency situations, rendering the need for airway management infrequent, with difficulties arising even more rarely. Supraglottic airway devices are reserved for a carefully chosen subset of parturient and are only employed during the first and second trimesters for non-abdominal and non-obstetric procedures. Endotracheal intubation remains the primary and preferred method for securing the airway during cesarean deliveries when neuraxial anesthesia is not feasible due to significant concerns. The use of video laryngoscopy enhances glottic visualization and may improve the success rate of first-pass intubation.

Conclusion: The anesthesia team should engage in discussions with the surgical and/or obstetric teams regarding the risks and benefits of proceeding with the procedure once ventilation attempts are successful. When considering extubation, it is essential that pregnant patients are extubated while fully awake at the conclusion of surgery to ensure the preservation of protective airway reflexes.