Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some?

Metodiev, Yavor; Mushambi, Mary

doi:10.1016/j.bja.2020.02.012

Cited by 15 publications

(29 citation statements)

References 46 publications

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“…However, this issue is a subject of ongoing debate in light of recent evidence regarding gastric emptying during delivery and postpartum and the use of gastric ultrasound in the obstetric population. This point-of-care ultrasound examination allows to estimate the potential risk of aspiration resulting from gastric content volume assessment; however, further development is needed in the obstetric patient population to provide evidence allowing to identify women at low risk of aspiration relevant for airway management with supraglottic airways [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice

Krawczyk

Jaśkiewicz

Huras

et al. 2022

JCM

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There are many benefits of neuraxial anesthesia (NA) in the obstetric population. We performed a retrospective analysis of anesthesia provided to obstetric patients in the tertiary care center between 1 January 2014 and 31 December 2020 and the influence of the COVID-19 pandemic on anesthetic practice. A total of 15,930 anesthesia procedures were performed. A total of 2182 (17.52%) cesarean sections (CS) required general anesthesia (GA), including 383 (3.07%) of emergency conversion from NA. NA for CS consisted of 9971 (80.04%) spinal anesthesia (SA) and 304 (2.44%) epidural anesthesia (EPI). We found a decrease in the GA rate for CS in 2020 (11.87% vs. 14.81%; p < 0.001). The conversion rate from NA to GA for CS was 2.39% for SA and 31.38% for EPI. The conversion rate from labor EPI to SA for CS increased in 2020 (3.10% vs. 1.24%; p < 0.001), as well as the SA rate for other obstetric procedures (61.32%; p < 0.001). We report 2670 NA for vaginal delivery, representing 31.13% of all vaginal deliveries. NA constituted the vast majority of obstetric anesthesia. However, we report a relatively high incidence of GA. There was a decrease in GA use in the obstetric population during the pandemic. Further reduction in GA use is possible, including an avoidable conversion from NA to GA.

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Section: Discussionmentioning

confidence: 99%

Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice

Krawczyk

Jaśkiewicz

Huras

et al. 2022

JCM

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“…To avoid hemorrhage resulted from uterine atony, inhalational sevoflurane was switched into intravenous anaesthetics after umbilical cordligation. Notably, PPE increased the difficult in airway management and it was necessary for the use of visual laryngoscopes, and the supraglottic airway was considered as a remedy for failed tracheal intubation in emergency general anaesthesia 12 .…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Zhang

Chen

Wang

et al. 2020

Preprint

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Objective: To analyse the clinical features of COVID-19 parturients, and to compare anaesthetic regimen and clinical outcomes in parturients with or without COVID-19 undergoing cesarean delivery.Methods: Data were extracted from the electronic medical record of 3 medical institutions in Hubei Province, China, from June 1, 2019 to March 20, 2020 according to inclusion and exclusion criteria. After propensity score matching with demographics, the clinical and laboratory characteristics of parturients with or without COVID-19 were analysed. The anaesthetic regimen and clinical outcomes of themselves and their infants were compared in these two groups of parturients.Results: A total of 1,588 patients without SARS-CoV-2 infection undergoing cesarean delivery were retrospectively included. After achieving a balanced cohort through propensity score matching, 89 patients (COVID-19 group), who were diagnosed with COVID-19 by SARS-CoV-2 nucleic acid test and CT scan matched with 173 patients without COVID-19 (Control group). The SARS-CoV-2 infected parturients in the early stages of COVID-19 outbreak was much more than during the later stage. The main clinical characteristics of parturients with COVID-19 were fever (34.8%), cough (33.7%), an increased plasma CRP (52.8%) and a decreased lymphocyte counting (33.7%). A high rate of emergency and a high incidence of anaesthesia-related complications, such as pharyngalgia, multiple puncture, intraoperative hypotension, nausea, vomiting, vertigo and chills in the COVID-19 parturients. In addition, the parturients with COVID-19 had a long duration of operation and hospital stay, and an increased intraoperative oxytocin utilization and postoperative oxygen therapy. The newborns from the SARS-CoV-2 infected mothers, who received general anaesthesia, had a high risk of Apgar score ≤ 8 at 1 and 5 minutes after delivery and a higher rate of neonatal intensive care unit (NICU) admission.Conclusions: Anaesthesia-related complications occur more frequently in the COVID-19 parturients and their newborns have a high risk of distress.

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“… 58 – 60 , 264 With most using second-generation SGAs, the studies indicate a high success rate and minimal occurrence of gastric content aspiration. 265 Notwithstanding, the CAFG does not currently espouse SGA use for elective CD. This position might change as the role of ultrasound in assessing gastric contents and aspiration risk becomes more understood.…”

Section: The Obstetric Patient—special Considerationsmentioning

confidence: 99%

“…This position might change as the role of ultrasound in assessing gastric contents and aspiration risk becomes more understood. 265 …”

Section: The Obstetric Patient—special Considerationsmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. Findings and key recommendations Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider “exit strategy” options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a “cannot ventilate, cannot oxygenate” emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as “airway lead” to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.

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Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some?

Cited by 15 publications

References 46 publications

Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice

Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

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