Acute pharyngolaryngeal oedema in a pre-eclamptic parturient with systemic lupus erythematosus and a recent renal transplant

O'Connor, R.; Thorburn, J.

doi:10.1016/0959-289x(93)90032-d

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…laryngeal or tracheal oedema in patients with pre-eclampsia or after traumatic intubation) or there is a concern with oxygenation, supplementary airway evaluation by direct laryngoscopy, fibreoptic examination or confirmation of an audible leak around a tracheal tube with the cuff deflated may be required. Transfer to the intensive care unit for controlled ventilation and delayed extubation may be appropriate [ 20 , 158 , 160 , 161 ].…”

Section: Extubation Of the Tracheamentioning

confidence: 99%

“…These changes result in increasing Mallampati score as pregnancy progresses, and also during labour and delivery . Swelling may be exacerbated by pre‐eclampsia , oxytocin infusion, intravenous fluids and Valsalva manoeuvres during labour and delivery . Decreased functional residual capacity and increased oxygen requirements accelerate the onset of desaturation during apnoea, and these are exacerbated in the obese parturient.…”

Section: Why Is Airway Management More Difficult In the Obstetric Patmentioning

confidence: 99%

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Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

et al. 2015

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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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Section: Extubation Of the Tracheamentioning

confidence: 99%

Section: Why Is Airway Management More Difficult In the Obstetric Patmentioning

confidence: 99%

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

et al. 2015

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Section: Extubation Of the Tracheamentioning

confidence: 99%

“…These changes result in increasing Mallampati score as pregnancy progresses, and also during labour and delivery [14][15][16][17][18]. Swelling may be exacerbated by pre-eclampsia [19,20], oxytocin infusion, intravenous fluids and Valsalva manoeuvres during labour and delivery [15,16,21]. Decreased functional residual capacity and increased oxygen requirements accelerate the onset of desaturation during apnoea, and these are exacerbated in the obese parturient.…”

Section: Classification Of Evidencementioning

confidence: 99%

“…In addition to lateral uterine displacement as indicated, the head-up position should be considered. A [20][21][22][23][24][25][26][27][28][29][30] o head-up position increases functional residual capacity in pregnant women [53] and safe apnoea time in nonpregnant obese and non-obese patients [54][55][56][57]. It also decreases difficulty with insertion of the laryngoscope caused by large breasts, improves the view at laryngoscopy [58] and may reduce gastro-oesophageal reflux [59].…”

Section: Rapid Sequence Inductionmentioning

confidence: 99%

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Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe 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 secondgeneration) 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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Simulation of Difficult Airway Management in Obstetric Emergencies

Beck,

Salatto,

Ferrara

et al. 2023

Practical Guide to Simulation in Delivery Room Emergencies

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Acute pharyngolaryngeal oedema in a pre-eclamptic parturient with systemic lupus erythematosus and a recent renal transplant

Cited by 9 publications

References 14 publications

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Simulation of Difficult Airway Management in Obstetric Emergencies

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