Obstetric Anesthesia

Anesthesia for Cesarean Delivery

The Unanticipated Difficult Intubation in Obstetrics

Mhyre JM, Healy D (The Univ of Michigan Health System, Ann Arbor) Anesth Analg 112:648-652, 2011^§

Abstract

In this focused review, we discuss an algorithm specifically for the unanticipated difficult intubation in obstetrics. This generic algorithm emphasizes a standardized and prespecified sequence of interventions to provide safe, efficient, and effective airway management for the emergency obstetric surgical patient. Individual institutions and anesthesia providers are encouraged to use this framework to select specific pieces of equipment for each step, and to create regular opportunities for all obstetric anesthesia providers to become facile with each airway device and to integrate the algorithm under simulated conditions (Fig 1, Table 2).

Figure 1 Suggested algorithm. *Adjust cricoid pressure; backward, upward, rightward pressure (BURP); bougie; minor position adjustments. ^†Oral airway, jaw thrust, adjust cricoid pressure, 2-handed technique. (Reprinted from Mhyre JM, Healy D. The unanticipated difficult intubation in obstetrics. Anesth Analg. 2011;112:648-652, with permission from International Anesthesia Research Society.)

Table 2 Options for Secondary Intubation Equipment

	Manufacturer
Direct laryngoscopes
McCoy blade
Miller blade inserted by a paramolar approach
Intubation guides
LMA FasTrach™ ± fiberoptic bronchoscope	LMA North America, San Diego, CA
Air-Q™ ± fiberoptic bronchoscope	Cookgas, St. Louis, MO
Lighted stylet
Videolaryngoscopes
C-Mac®	Karl Storz, Tuttlingen, Germany
GlideScope®	Verathon Medical, Bothell, WA
Airtraq®	Prodol Ltd., Vizcaya, Spain
Pentax-AWS™	Hoya Corp., Tokyo, Japan
Truview EVO2™	Truphatek Holdings Ltd., Netanya, Israel
McGRATH® Series5	Aircraft Medical, Edinburgh, UK
McGRATH® MAC	Aircraft Medical, Edinburgh, UK
Coopdech® C-Scope	Daiken Medical Co., Osaka, Japan
Optical stylets
Bonfils™	Karl Storz, Tuttlingen, Germany
Levitan™	Clarus Medical, Minneapolis, MN
Shikani SOS™	Clarus Medical, Minneapolis, MN
Video System™ (CVS)	Clarus Medical, Minneapolis, MN
Video RIFL®	AI Medical Devices, Inc., Williamston, MI

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