A895 Airway Changes During Pregnancy

Shankar, Bhavani K.; Krishna, S. A.; Moseley, H.

doi:10.1097/00000542-199709001-00895

Cited by 5 publications

(5 citation statements)

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“…In addition, pregnancy induced hypertension, upper respiratory tract infection, stridor and voice changes may suggest the presence of airway oedema. Weight gain in excess of 15 kg during pregnancy has been shown to be associated with an increase in suboptimal laryngoscopic views [57].…”

Section: Perinatal Outcomes Of Obesitymentioning

confidence: 99%

Obesity and obstetric anaesthesia

Saravanakumar¹,

Sg²,

2005

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Summary The prevalence of obesity continues to increase despite preventive strategies. Obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases such as pre‐eclampsia and gestational diabetes. Moreover, they have a tendency to labour abnormally contributing to increased instrumental delivery and Caesarean section. Obesity is a risk factor for anaesthesia related maternal mortality. Morbidly obese women must be considered as high‐risk and deserve an anaesthetic consultation during their antenatal care. The significant difficulty in administering epidural analgesia should not preclude their use in labour. A more liberalised use of regional techniques may be a means to further reduce anaesthesia‐related maternal mortality in the obese population. The mother's life should not be jeopardised to save a compromised fetus. Prophylactic placement of an epidural catheter when not contraindicated in labouring morbidly obese women would potentially decrease anaesthetic and perinatal complications associated with attempts at emergency provision of regional or general anaesthesia. Early mobilisation, aggressive chest physiotherapy and adequate pain control are essential components of effective postoperative care.

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Section: Perinatal Outcomes Of Obesitymentioning

confidence: 99%

Obesity and obstetric anaesthesia

Saravanakumar¹,

Sg²,

2005

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“…7 The risk may increase further if the patient has other risk factors such as obesity, protruding upper teeth, short thyromental distance, and increased weight gain in the pregnancy. 8 In addition, the laryngeal edema that may accompany upper airway edema can also contribute to a difficult intubation. It may be prudent to induce general anesthesia and secure the airway as soon as substantial hemorrhage, requiring large volume infusion/transfusion, is anticipated.…”

Section: Discussionmentioning

confidence: 99%

Airway changes during cesarean hysterectomy

Bhavani-Shankar

Lynch

Datta

2000

Can J Anesth/J Can Anesth

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Purpose: To document whether hemorrhage and fluid administration during peripartum hysterectomy results in changes in the airway that may predispose to subsequent difficult intubation, in the event that intraoperative general anesthesia is required during regional anesthesia.Clinical features: A 32-yr-old underwent peripartum hysterectomy for placenta accreta. Blood loss of 5.5 L occurred during surgery requiring 6 L crystalloid, 1 L hetastarch, five units packed RBCs and two units fresh frozen plasma. Airway changes were followed using Samsoon's modification of Mallampati airway classification. In addition, airway photographs were obtained using a Polaroid camera. The airway of the patient changed from class 2 preoperatively to class 4 in the immediate postoperative period. The airway gradually returned to normal over the ensuing 48 hr, during which a negative fluid balance of 4 L occurred due to substantial postoperative diuresis.Conclusion: Peripartum airway changes were detected during Cesarean hysterectomy and fluid resuscitation that gradually returned to normal within 48 hr after surgery.Objectif : Vérifier si une hémorragie et l'administration de liquide pendant une hystérectomie péripartum peut modifier l'intubation prédisposant à une intubation difficile subséquente, dans le cas où une anesthésie générale peropératoire serait nécessaire pendant l'anesthésie régionale.Éléments cliniques : Une femme de 32 ans a subi une hystérectomie péripartum à cause d'un placenta accreta. Une perte sanguine de 5,5 L est survenue pendant l'opération et a nécessité 6 L de cristalloïde, 1 L de hetastarch, cinq culots globulaires et deux unités de plasma frais congelé. Les changements de l'intubation ont été observés grâce à la modification de Samsoon de la classification de Mallampati. De plus, des photographies de l'intubation ont été réalisées avec une caméra Polaroïd. L'intubation du patient est passée de la classe 2, avant l'opéra-tion, à la classe 4, immédiatement après. Elle est graduellement revenue à la normale au cours des 48 h qui ont suivi et durant lesquelles un bilan hydrique négatif de 4 L est survenu, causé par une importante diurèse postopératoire.Conclusion : Les changements dans l'intubation péripartum ont été détectés pendant l'hystérectomie postcésari-enne et la réanimation liquidienne qui se sont graduellement normalisés pendant les 48 h qui ont suivi l'intervention chirurgicale.

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“…Furthermore, obese parturients have a much higher incidence of failed intubation (0.35%) than obese nonpregnant surgical patients (0.04%), indicating that obesity and pregnancy can additively worsen the intubating condition [8]. Indeed, when the gestational weight gain is more than 15 kg, a suboptimal laryngoscopic view is four times as frequent as among nonpregnant women at the corresponding age [9].…”

Section: Airwaymentioning

confidence: 99%

“…Furthermore, the laryngoscopic view may be narrowed owing to the enlarged tongue and fleshy pharyngeal and supralaryngeal soft tissue. A recent study demonstrated that a weight gain of more than 15 kg during pregnancy is associated with a threefold increase in the incidence of suboptimal laryngoscopic views, as compared with nonpregnant women at the corresponding age [9]. Only through a complete preoperative evaluation of the airway can a possibly difficult laryngoscopy or failed intubation be predicted and a step-by-step strategy for airway management be planned.…”

Section: Respiratory System and Airwaymentioning

confidence: 99%

“…As a result, morbidly obese patients have at least a twofold increase in surgical mortality in general [6]. Moreover, a positive correlation has been found between gestational weight gain and increased risks of poor laryngoscopic view, abnormal labor, certain fetal abnormalities, and unscheduled cesarean section [8,9]. In this article, we discuss some important aspects of obesity-induced pathophysiology relevant in anesthetic practice and review the limited available literature regarding the clinical implications of obesity in parturients.…”

Section: Introductionmentioning

confidence: 99%

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