Failed intubation in obstetrics

Brien, Kate O.; Conlon, Clare

doi:10.1016/j.mpaic.2013.05.011

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Obesity is a risk factor for awareness, and the obstetric population includes significant numbers of obese patients . A single ampoule of suxamethonium is frequently used to provide neuromuscular blockade during rapid sequence induction but, because of patient size and the increased volume of distribution in pregnancy, this may often be inadequate, making tracheal intubation more difficult and time‐consuming; this further increases the risk of awareness .…”

Section: Accidental Awareness Under General Anaesthesiamentioning

confidence: 99%

“…The failed tracheal intubation rate may be higher in pregnant women for a number of reasons. In addition to the stress relating to the time‐critical nature of the procedure, which may degrade performance , anatomical changes occur which can make tracheal intubation more challenging. The larynx can become oedematous, particularly in pre‐eclampsia, and this can make it difficult to gain a view of the vocal cords or to pass a tracheal tube.…”

Section: Failed Tracheal Intubationmentioning

confidence: 99%

See 1 more Smart Citation

Complications in obstetric anaesthesia

Maronge

Bogod

2018

Anaesthesia

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Summary ‘Obstetric anaesthesia is a litigious area of medical practice – patient expectations are high, and many of the interventions undertaken by anaesthetists are performed urgently or emergently, frequently out of hours. The complications that occur during obstetric practice are not unique to this area of anaesthesia, but some of the physiological and anatomical changes that take place during pregnancy can affect the frequency with which these happen. In this narrative review, we hope to cover a few of the more common complications in obstetric anaesthesia, as well as some of the more severe, yet less frequently occurring problems.

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Section: Accidental Awareness Under General Anaesthesiamentioning

confidence: 99%

Section: Failed Tracheal Intubationmentioning

confidence: 99%

Complications in obstetric anaesthesia

Maronge

Bogod

2018

Anaesthesia

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“…Retrospective studies show that difficult ETI occurs infrequently, only around one in 50 intubations 2 . Changed patterns of airway management in clinical practice and decreased working hours have reduced the number of intubations performed by trainees 3 . To put this in perspective, Clarke 4 reported anaesthetic registrars in one Australian teaching hospital only encountered unexpected difficulty (grade 3 or 4 as defined by Cormack and Lehane 5 ) in 2.9% of an estimated mean of 157 intubations per year.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Difficult Endotracheal Intubation Simulator Designed for Use in Anaesthesia Training

Brettig¹,

Shurgott²,

Quinn

et al. 2017

Anaesth Intensive Care

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There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. A total of 130 participants comprising specialists, trainees and medical students volunteered for this study. Validity was tested using randomised between-groups comparison of the time taken to intubate the manikin on all settings. Overall, and at each setting, there was a significant difference between the times to intubation among the three levels of experience (P <0.001). Novices were more than 12 times more likely to fail than experts (odds ratio [OR] 12.4, 95% confidence intervals [CI] 3.8, 41.8, P <0.001). The median time to intubation for all three groups changed significantly between settings 1 (easiest) and 4 (most difficult), novice 18 seconds (CI 8.9, 27.1, P <0.001), intermediate 15 seconds (CI 6.5, 23.5, P=0.001), and expert 9 seconds (CI 0.4, 17.6, P=0.04). The novice group was significantly different from the expert group at all attempts (P <0.002), and from the intermediates at all attempts apart from the third (P=0.055). The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6, P=0.002) and intermediate 10 seconds (CI 1.0, 19.0, P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.

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