Difficult tracheal intubation in obstetrics

Cormack, R. S.

doi:10.1111/j.1365-2044.1986.tb12815.x

Cited by 163 publications

(213 citation statements)

References 2 publications

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“…Baseline values for MAP were similar in both groups (90 [13] and 92 [13] mmHg in the rocuronium and the succinylcholine groups, respectively). The lowest MAP values recorded were 64 (11) and 62 (12) mmHg, respectively, with no statistically significant difference between groups.…”

Section: Resultsmentioning

confidence: 79%

“…Heart rate was also similar at baseline (85 [18] and 80 [15] beats Á min -1 , respectively). However, the lowest HR value recorded was less in the succinylcholine group compared with the rocuronium group (67 [12] vs. 74 [13] beats min -1 , respectively; P \ 0.001). In the succinylcholine group, 12 patients developed a decrease of MAP by more than 25% from baseline value for 60 s, necessitating the use of ephedrine, whereas in the rocuronium group, four patients required ephedrine (P = 0.067).…”

Section: Resultsmentioning

confidence: 86%

“…Each laryngoscopy was graded using the standard Cormack and Lehane scoring system (1 = full view of the glottis; 2 = partial view of the glottis or arytenoids; 3 = only epiglottis visible; 4 = neither glottis nor epiglottis visible). 13 Before induction of anesthesia, surface electrodes were placed over the ulnar nerve at the wrist. After loss of consciousness, the ulnar nerve was stimulated at the wrist with a square wave stimulus set at a current of 40 mA and duration of 0.2 ms. Each stimulus was delivered in a train-of-four (TOF) sequence and repeated every 12 s using a TOF-Guard peripheral nerve stimulator (Acceleromyograph, Biometer, Organon Teknika NV, Belgium).…”

Section: Methodsmentioning

confidence: 99%

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Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Siddik-Sayyid

Taha

Kanazi

et al. 2009

Can J Anesth/J Can Anesth

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Purpose The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg Á kg -1 ) with intubating conditions 60 s after administering succinylcholine 1.5 mg Á kg -1 . Methods The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg Á kg -1 , remifentanil 2 lg Á kg -1 , and propofol 2 mg Á kg -1 administered over 30 s. In one group, rocuronium 0.3 mg Á kg -1 was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg Á kg -1 was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation. Results There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3). Conclusion During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg Á kg -1 administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg Á kg -1 administered after the induction sequence. RésuméObjectif La succinylcholine permet de re´aliser l'intubation trache´ale dans les plus courts de´lais, avec les meilleures conditions d'intubation et la dure´e la plus courte de paralysie musculaire. Au cours d'une induction de l'anesthe´sie avec lidocaı¨ne-re´mifentanil-propofol, nous avons compare´les conditions d'intubation 90 sec apre`s avoir administre´du rocuronium a`faible dose (0,3 mgÁkg -1 ) aux conditions d'intubation 60 sec apre`s avoir administre´de la succinylcholine a`1,5 mgÁkg -1 . Méthode Au total, 184 patients adultes sains devant subir une chirurgie non urgente ont pris part a`cette e´tude randomise´e en double aveugle. L'anesthe´sie a e´te´induite chez tous les patients avec de la lidocaı¨ne (1,5 mgÁkg -1 ), du re´mifentanil (2 lgÁkg -1 ) et du propofol (2 mgÁkg -1 ) administre´s sur une pe´riode de 30 sec. Dans un groupe, du rocuronium (0,3 mgÁkg -1 ) a éte´administre´avant la

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Section: Resultsmentioning

confidence: 79%

Section: Resultsmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Siddik-Sayyid

Taha

Kanazi

et al. 2009

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…The anesthesiologist used the Cormack and Lehane's scale to rate the grade of laryngoscopic view of the first tracheal intubation attempt. 18 …”

Section: Methodsmentioning

confidence: 99%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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“…It is not exaggerating to say that appropriate airway management during anesthesia has been developed mainly in the field of obstetric anesthesia: recognition of the risk of pulmonary aspiration (in the 1930s) [9], national surveys of serious airway complications during anesthesia (e.g., Confidential Enquiries into Maternal Death in the United Kingdom) [10], establishment of an optimal method of laryngoscopy (by Cormack and Lehane [11]), and the first algorithm for difficult airway management [12]. In the 1990s, the importance of airway management was recognized in nonobstetric patients as well, and several major efforts have been made: major guidelines about difficult airway management have been formulated, new reliable airway devices developed, and oximetry and capnography have become widely available.…”

Section: A Cautionary Tale…mentioning

confidence: 99%

Rapid-sequence induction of anesthesia in obstetric women: how safe is it?

Asai

2012

J Anesth

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A cautionary tale…A 35-year-old woman, 154 cm, 86 kg, with placenta previa and preeclampsia, had massive bleeding after consuming a lunch. She was immediately transferred to the operating room, where an anesthesiologist was called in. She was morbidly obese, having large breasts and a low-pitched voice (indicative of laryngeal edema), and the view of the oropharynx was obscured (Mallampati score 4). Awake tracheal intubation was attempted, but the patient refused to open her mouth. General anesthesia was induced as a rapid sequence, and tracheal intubation was attempted, but failed twice. A senior anesthesiologist was called in and accomplished intubation. Cesarean section was started. Soon after this, it was found that the tube was wrongly inserted into the esophagus. The tube was taken out and mask ventilation was attempted, but this was difficult. Arterial hemoglobin oxygen saturation rapidly decreased to 70 % with cardiac arrhythmia. Nevertheless, the baby was successfully taken out and the mother started to breathe. As the operation would continue, the laryngeal mask airway was inserted. The mother vomited and aspirated. This is a fiction, but we all might have heard about a real story like this. And, what was wrong with this case? Why cannot we clearly answer what should have been done to this case?In this issue of the Journal, Tao et al.[1] report a retrospective analysis of pregnant women who underwent general anesthesia during 2001-2006 in a teaching hospital, to obtain the incidence of 'difficult airway,' which was defined as follows: necessity of three or more attempts at direct laryngoscopy, the use of any maneuvers or techniques outside the rapid sequence induction routine (including mask ventilation resulting from oxygen desaturation from unsuccessful intubation attempts), the use of additional airway equipment, or inability to intubate the trachea. The incidence was 0.56 % (12 of 2,158 patients). They state that tracheal intubation was possible in more than 99.9 % of pregnant patients, and the incidence of difficult airway in pregnant patients is no higher than the incidence in nonpregnant patients. They attempted to seek factors contributing to the difficult airway, and have found that the lack of experience of anesthesia providers increased the incidence, whereas emergency cesarean section did not add another level of difficulty over planned cesarean section [1].So, can we conclude that tracheal intubation in pregnant women is as easy as in nonpregnant patients? The reported incidence in the general population of difficult tracheal intubation is about 1 %, and that for difficult facemask ventilation is as much as 5 % [2-4]. Therefore, it seems reasonable to conclude that the incidence in pregnant patients may be similar to, or not much higher than, the incidence in the general population.Can we then state that the pregnant patients are not at increased risk of serious airway complications during anesthesia? To answer this question, we need to know the risk in the general population. Until recent...

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Difficult tracheal intubation in obstetrics

Cited by 163 publications

References 2 publications

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Rapid-sequence induction of anesthesia in obstetric women: how safe is it?

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