Difficult Airway in the Parturient

February 24, 20111015-1215H

35 y/o G1P0 41 weeks AOG

Scheduled for Caesarean section due to severe fetal bradycardia

HeightWeight

160 cm72 Kg

Past Medical History Unremarkable

Pertinent obstetric history

18 months pta for a simple gynecologic procedure without complication

NPOLight mealChocolate

6 hours ago4 hours ago

35 y/o G1P0 41 weeks AOG

• No symptoms of gastro-esophageal reflux• Obstetrician in haste to deliver

1. What is the anesthetic technique of choice?a. Spinalb. Epiduralc. General Anesthesiad. Others

35 y/o G1P0 41 weeks AOG

2. If you choose to do it under general anesthesia, what muscle relaxant will you use to facilitate orotracheal intubation?

a. Succinylcholineb. Atracuriumc. Rocuroniumd. Vecuronium

General Anesthesia

• 2 attempts of intubation facilitated by a gum elastic bougie: FAILED

• O2 saturation: 55%• Positive pressure ventilation w/ facemask – O2 saturation: 88%Size 4 proseal inserted positive pressure

ventilation: SpO2 98%

35 y/o G1P0 41 weeks AOG

3. Do you agree with the management of the anesthesiologist?

4. What other options do you suggest?a. LMA Classicb. IGELc. Fastrachd. Others

35 y/o G1P0 41 weeks AOG

5. Will you allow the obstetrician to proceed with the cesarean section under general anesthesia (O2 sevoflurane atracurium) using LMA?

35 y/o G1P0 41 weeks AOG

6. Is there an advantage in using proseal LMA over the classical LMA in cases like this? Do you have other suggestions?

35 y/o G1P0 41 weeks AOG

• 7. How would you check for the adequacy of ventilation intraoperatively?a. Auscultationb. Pulse oximetryc. Capnographyd. ABG

35 y/o G1P0 41 weeks AOG

8. If you have difficulty ventilating the patient, what you do?

a. Replace proseal with another proseal 4b. Replace proseal with fastrach and

intubatec. Don’t do anything, just pray nothing

happens d. Others

Intraoperatively

• The patient developed laryngospasm

9. What will you do next?a. Positive pressure ventilationb. Give a muscle relaxantc. Extubated. Wake the patient up

Intraoperatively

10. Is there a way of knowing whether the patient has aspirated or not using this technique ( GA-LMA)?

Some more Questions:

• Can you insist on doing a spinal?• What if the anesthesiologist is not

comfortable with General anesthesia?

THANK YOU VERY MUCH!The end