Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

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Abstract

(Anaesthesia. 2015;70(11):1286–1306)

This paper presents the first national obstetric-specific failed intubation guidelines in the United Kingdom. These guidelines were developed by a working group commissioned by the Obstetric Anaesthetists’ Association and the Difficult Airway Society UK. The guidelines include specific measures to account for the physiological and physical changes of pregnancy, which significantly affect oxygenation and airway management, as well as the need to consider both maternal and fetal status when making decisions regarding management of the difficult airway. They also provide a structure for advance planning in the event that failed intubation were to arise. There is a need for standardizing the approach to obstetric failed intubation as the number of obstetric general anesthetics has been declining over the last 3 decades as regional anesthesia has become more popular. As a result, experience in managing the obstetric airway in general and the specific situation of difficult intubation has declined, especially among anesthesia trainees. In addition, other trends in anesthesia care, such as the increased use of supraglottic airway devices (SADs), has led to a decrease in the use of some specific airway skills, including bag/mask ventilation and tracheal intubation.

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