The role of supraglottic airway devices in obstetric anaesthesia

Abstract

Purpose of reviewTo discuss the role of supraglottic airway devices as rescue and primary airway devices in pregnant patients.Recent findingsGeneral anaesthesia in pregnant patients is associated with increased incidence of difficult and failed intubation, especially when performed for caesarean deliveries. The Difficult Airway Society and the Obstetric Anaesthetists’ Association guidelines for the management of failed intubation recommend the use of second-generation supraglottic airway devices as a rescue airway strategy when failed intubation occurs. This practice is now widely accepted and embedded in routine teaching and clinical practice. On the other hand, there is little but growing evidence describing the use of supraglottic airway devices as the primary airway device and an alternative to endotracheal intubation for patients undergoing elective and emergency caesarean deliveries under general anaesthesia. Most of the published research supporting this practice was done on carefully selected patients who were nonobese and who did not have gastroesophageal reflux or anticipated difficult airway. Despite demonstrating high insertion success rates and low complication rates, these studies were underpowered and have thus far, failed to provide robust data on the true risk of aspiration in this setting.SummaryBased on current scientific data, the evidence for the safe use of supraglottic airway devices as primary airway devices during general anaesthesia for caesarean deliveries is not compelling. However, their use as rescue airway devices remains a well established strategy supported by international guidelines.

Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study

“…As we know, pregnant patients are considered “full stomach” due to pregnancy-related physiological changes. Before the routine use of ultrasound as a screening tool to accurately assess gastric content in obstetric patients, whether the second-generation LMA could replace tracheal intubation as a primary airway device remains a more controversial topic ( 16 , 17 , 32 ). Although high-quality research supporting recommended use of the LMA Supreme is still lacking, our obstetric anesthetist should be encouraged to use this airway instrument in obstetric clinic practice.…”