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Retrospective review of the routine use of videolaryngoscopy with the Storz C-MAC video laryngoscope in obstetric patients
Abstract Number: S-24
Abstract Type: Original Research
Introduction: It is well established that pregnant patients have higher rates of difficult direct laryngoscopy(DL) during endotracheal intubation. Videolaryngoscopy has been used with success in other populations with anticipated difficult airways1. The Storz C-MAC videoscope is designed for DL with a traditional Macintosh blade, but has the option of using a screen for indirect videolaryngoscopy. We implemented a standard protocol that every obstetric patient is intubated with the Storz C-MAC. DL with the C-MAC blade is first attempted and ETT placed if cords are visualized. If DL is unsuccessful, the C-MAC screen is used to assist with cord visualization and intubation. This study aims to examine the need for rescue via videoscope and the patient comorbidities that may require videoscope endotracheal intubation.
Methods: We obtained billing data for all obstetric cases under general anesthesia (May 12th 2012-January 11th, 2015). Records were hand searched for inclusion criteria of general anesthesia on the day of delivery and greater than 20 weeks GA. From each record, patient demographics, comorbidities, urgency for surgery, and intubation details were collected. Groups were compared with descriptive, univariate, and bivariate statistics and logistic regression modeling.
Results: 167 subjects were identified, 39 did not meet inclusion, 5 intubations were via other techniques, and 19 were excluded due to protocol violations. In the remaining 104 subjects, 88 (85%) were successfully intubated via DL with the Storz C-MAC. 16 subjects (15%) required rescue with the Storz C-MAC screen, indicating difficult intubation. Storz C-MAC (Successful DL) and (Rescue with Screen) groups were compared and no statistical difference was found between the groups in patient BMI, rate of pre-eclampsia, urgency of surgery or Mallampati class.
Conclusion: In our study, 15% of our patients were considered to be “difficult direct laryngoscopy” and required rescue with videoscreen, but all patients were successfully intubated with the Storz C-MAC. Patients requiring rescue had smaller mean BMIs, lower rates of pre-eclampsia, and equivalent urgency of surgery and MP class. This study indicates that the routine use of Storz C-MAC is effective in obstetric patients and traditional markers of difficult airway may be less predictive in the obstetric population.
Aziz, M. F., et al. (2012). Anesthesiology 116(3): 629-636.