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Changing Trends In the Management of the Obstetric Airway
Abstract Number: S-11
Abstract Type: Original Research
Introduction: Over the last 40 years, newer technologies (fiberoptics, LMAs, video laryngoscopes ) have enabled the anesthesiologist to better manage the maternal airway. Have these devices decreased the incidence of failed intubation?
Methods: We reviewed our maternal airway database for the years 1974 – 2010 to determine the overall incidence of failed rigid laryngoscopy during general anesthesia for cesarean section and the need to use alternative airway devices.
Results: During the first decade of this review, 1974 – 1983, failed rigid intubation(FRI) occurred at a rate of 1/224 (9/2016). Airway rescue was successful in six cases after spontaneous ventilation returned followed by blind nasal intubation. Over the time span of the next twenty years, 1984- 2003, FRI occurred at a rate of 1/756 (3/2268) while preemptive sedated fiberoptic intubation occurred at a rate of 1/7 (323/2268). During the past seven years, FRI occurred at a rate of 1/57 (9/518) with the rate of sedated fiberoptic intubation at 1/18 (29/518).
Discussion : The overall rate of failed intubation is increasing. This could be due to three factors (1) Failed rigid laryngoscopy can be easily handled by alternative techniques (2)prediction of difficult rigid laryngoscopy has not improved over the past forty years (3) older skills are being lost .