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Obstetric Difficult Airway Management (SASA 2014 Airway Workshop)

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by

Ross Hofmeyr

on 22 February 2015

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Transcript of Obstetric Difficult Airway Management (SASA 2014 Airway Workshop)

What's the problem?
Emergency Mx
Difficult Airway Management in Obstetrics
25 years ago - 79% had GA

By 1998 in Leeds: 4 per trainee!

Plea for dedicated training in obstetric tracheal intubation
Difficult intubation incidence 1:100-250

3 recent papers quote similar rate as for general population

What is our experience?
How do we avoid it?
Premonition
Preparation
Positioning
Preoxygenation
Unfailingly assess every airway!
Routine Airway Mx
Urgency
Limited access
Obesity
Pre-eclampsia
Cardiac failure
Increased
risk of reflux
Rapid
desaturation
MABELS
Assess, Prep, Position, PreOx
RSI vs Graded Induction
Effective mouth opening
Intubate...or not?
Cricoid pressure?
Preload introducer in ETT
Induction agent?
Opiates?
Magnesium?
Sux vs Roc?
Approach to intubation in eclampsia

Probably safe to do RA if GCS is normal
If evidence of
cerebral oedema
:
Sedate
Arterial line
Bitten tongue = inhalational technique
Fibreoptic intubation questionable!
Stay pink
5x longer!
Airway oedema
2 min TV breathing, or
7 vital capacity breaths, or
EtO2 > 0.9
Full transcript