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Airway Management for 377 Cesarean Deliveries Under General Anesthesia
Abstract Number: T2A-297
Abstract Type: Original Research
INTRODUCTION: In the SCORE study, D’Angelo and colleagues reported that failed intubation occurs as frequently as 1 out of every 533 cesarean deliveries (CD) under general anesthesia (GA)1. In 2013, our department liberalized our approach to GA for CD in response to a series of morbidity and mortality conferences where presented patients underwent CD with apparent inadequate analgesia. From 2014 to 2018, our department made capital investments in equipment that resulted in a greater availability of video laryngoscopes. Our primary aim was to determine how airways were ultimately secured when CD was performed under GA and our secondary aim was to report serious complications arising from airway management.
METHODS: Using a combination of our electronic medical record system and the official labor and delivery handwritten log of deliveries, we verified capture of every CD from July 1, 2014 to June 30, 2018. Demographic information for each CD as well as information on the mode of laryngoscopy, number of intubation attempts, how the airway was secured, and any complications were recorded.
RESULTS: 377 subjects had GA for CD; 364 of these subjects had complete data regarding airway management. 275, 89, and 3 subjects had airways that were ultimately secured with direct laryngoscopy (DL), video laryngoscopy (VL), and fast track laryngeal mask airway (LMA), respectively. Table 1 illustrates the use of direct and video laryngoscopy stratified by academic year. Complications included one aspiration that occurred during an emergent CD and one airway that wasn’t secured until after delivery (a LMA was used as a temporizing measure). All airways were eventually secured with an endotracheal tube with no surgical airways.
DISCUSSION: Most of the airways in CD under GA were secured by DL with one attempt. The use of VL increased as equipment became more available. Fast track LMA was used to secure three airways; there is not enough data to determine if VL was available at the time. We had no failed airways and one aspiration; our study was not powered to measure serious complications. Further studies are needed with detailed data on airway management to determine best practices for CD under GA.
1. D’Angelo R, et al. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2014;120:1505-12