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Concordance of Predicted Difficult Airway and Back Parameters with Difficult Labor Epidural Placements - A Prospective Observational Study
Abstract Number: T-14
Abstract Type: Original Research
Introduction: Pregnancy invokes significant anatomic and hormonal changes that have anesthetic implications. While clinicians, including anesthesiologists, often focus on features associated with a “difficult airway”, those associated with a “difficult back” (i.e., difficult neuraxial technique) are seldom evaluated systematically. The aims of this study were to determine the concordance rate between difficult airway and back features, and if airway parameters could be predictive of difficult labor epidural placements.
Methods: A list of parameters associated with a difficult airway and back were identified through a literature review; continuous variables were dichotomized according to published cut-off values. These parameters were prospectively collected in term parturients. An independent co-investigator recorded provider duration of epidural placement using standardized start and end times. Difficult epidural technique placement was defined as duration of placement greater than 4.2 minutes. Concordance rate was determined using the number of patients with concordant difficult airway and back parameters. A logistic regression model was used to determine airway parameters associated with difficult epidural placements.
Results: To date, 192 of 400 patients have been recruited. Concordance rates for predicted difficult airway and back parameters are displayed in Fig 1. Patients with larger neck circumference (OR 1.1; 95% CI = 1.01-1.19; p=0.032) and higher BMI (OR 1.11; 95% CI =1.04-1.17; p=0.001) were associated with difficult epidural placements.
Discussion: In laboring parturients, larger neck circumference and elevated BMI are significantly associated with difficult epidural placements; these parameters have a high concordance rate with difficult back features. Our data suggest that these two simple physical assessments, which are quick to obtain and typically associated with difficult intubation, can be used to predict difficulty of epidural placements.
1. Guglielminotti J et al. Reg Anesth Pain Med 2013
2. Clark A et al. IJOA 2015