Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry

Smit, M.I.; Toit, Leon du; Dyer, Robert A.; Dyk, Dominique van; Reed, A.R.; Lombard, Carl; Hofmeyr, Ross

doi:10.1016/j.ijoa.2020.10.012

Cited by 10 publications

(3 citation statements)

References 24 publications

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“…This effect is more pronounced in patients with hypertensive disorders of pregnancy (HDP). 20 Increasing use of neuraxial anesthesia for labor and cesarean delivery has attenuated the increased risk of aspiration due to physiological changes of pregnancy. A functional epidural obviates the need for airway management in many urgent or even emergent cesarean delivery cases.…”

Section: Physiological Changes In Pregnancymentioning

confidence: 99%

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Resuscitation in obstetric care

Brennan,

Angelidis

2023

International Anesthesiology Clinics

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Section: Physiological Changes In Pregnancymentioning

confidence: 99%

“…Lastly, as previously discussed, FRC is reduced during pregnancy, making hypoxia with induction more common. This effect is more pronounced in patients with hypertensive disorders of pregnancy (HDP) 20 …”

Section: Airway Management In the Obstetric Patientmentioning

confidence: 99%

Resuscitation in obstetric care

Brennan,

Angelidis

2023

International Anesthesiology Clinics

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“…2 In patients with a hypertensive disorder of pregnancy (defined as gestational hypertension, preeclampsia, or eclampsia), there is more rapid desaturation during apnea after induction of anesthesia and during tracheal intubation. 3 There is also a higher risk of neurological complications due to hypertension during tracheal intubation and more neonatal respiratory depression. 4 Therefore, in the absence of epidural anesthesia for labor, the method of choice for CS is spinal anesthesia (SA), particularly in resource-limited settings.…”

mentioning

confidence: 99%

General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry

Seymour

Fernandes

Dyer

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND:In resource-limited environments, spinal anesthesia (SA) is preferred for cesarean delivery. In women at risk of spinal epidural hematoma, particularly those with hypertensive disorders of pregnancy, thrombocytopenia should be excluded before neuraxial blockade. In the context of emergency surgery for fetal distress, this investigation may be hampered by laboratory services being unavailable or off-site. METHODS: The Obstetric Airway Management Registry (ObAMR) is currently active across all anesthesia training institutions affiliated with the University of Cape Town. This multicenter observational study aimed to estimate the proportion of patients receiving general anesthesia (GA) for either confirmed or suspected thrombocytopenia, which was not excluded due to unavailability of laboratory results. To establish the number of GA uses that may have been avoided if platelet counts were available, we retrospectively searched for subsequent platelet counts in patients for whom thrombocytopenia was suspected. An algorithm was proposed, including a simple decision aid for estimating risk versus benefit of SA versus GA, to be followed in the setting of hypertensive disorders of pregnancy and thrombocytopenia. RESULTS: Thrombocytopenia was the indication for GA in 100 of 591 patients (16.9%) captured in the registry. In total, 48 of 591 (8.1%) had confirmed thrombocytopenia, and 52 of 591 (8.8%) had suspected thrombocytopenia. Of these patients, 91 of 100 had a hypertensive disorder of pregnancy. In the confirmed thrombocytopenia group, the indication for GA was a platelet count <75 × 10 9 /L. In the suspected thrombocytopenia group, 46 of 52 (88.5%) platelet counts could be retrospectively traced. The median (interquartile range) platelet count was 178 × 10 9 /L (93 -233 × 10 9 /L), and platelets exceeded 75 × 10 9 /L in 41 of 46 patients (89.1%). In the 5 of 46 patients with retrospectively confirmed thrombocytopenia, 2 had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. CONCLUSIONS: In 17% of patients, the indication for GA was thrombocytopenia. Of these, 52 of 100, or nearly 9% of the total of 591, received GA because a platelet count was unavailable at the time of surgery. The importance of early laboratory assessment, when available, should be emphasized. Overall, 41 of 591 (6.9%) had a platelet count >75 × 10 9 /L and would not have needed GA if their platelet count had been known. After following the constructed algorithm and applying the decision aid to assess risk and benefit, there may be circumstances in which the clinician justifiably opts for SA when a platelet count is indicated but unavailable.

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