Rescue supraglottic airway devices at caesarean delivery: What are the options to consider? |
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| Institution: | 1. Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore;2. Department of Women’s Anaesthesia, KK Women’s & Children’s Hospital, Singapore;1. Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic;2. 1st Department of Surgery – Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic;1. Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin Street, Suite A-3300, Houston, TX 77030, USA;2. Abigail Wexner Research Institute, Center for Regenerative Medicine, Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH 43205, USA;1. Department of Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA;2. Department of Neurosurgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA;3. Department of Anesthesiology, Perioperative, and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA;1. School of Nursing & Midwifery, Division of Health Science, University of South Australia, Adelaide, SA, Australia;2. College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia;3. Adelaide University, Adelaide, SA, Australia;4. Women’s and Children’s Hospital, North Adelaide, SA, Australia |
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| Abstract: | Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. Failed intubation is associated with a further increased risk of aspiration, therefore there is an argument for performing supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric population, it protects the airway and it minimises task fixation on repeated attempts at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation.Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI. |
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| Keywords: | Bronchoscopes Intubation Airway management Caesarean delivery Airway supraglottic |
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