Highlights
- •Obstetric difficult airway is associated with increased morbidity and mortality.
- •Supraglottic airway devices (SAD) allow rescue ventilation in obstetric patients.
- •Bronchoscopic intubation via a SAD has a high success rate.
- •Various obstetric factors determine whether to proceed with SAD guided intubation.
Abstract
Tracheal intubation is considered the gold standard means of securing the airway in
obstetric general anaesthesia because of the increased risk of aspiration. Obstetric
failed intubation is relatively rare. Difficult airway guidelines recommend the use
of a supraglottic airway device to maintain the airway and to allow rescue ventilation.
Failed intubation is associated with a further increased risk of aspiration, therefore
there is an argument for performing supraglottic airway-guided flexible bronchoscopic
intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric
population, it protects the airway and it minimises task fixation on repeated attempts
at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy,
there is a lack of specific recommendations or indications for SAGFBI in current obstetric
difficult airway guidelines in relation to achieving tracheal intubation.
Our narrative review explores the issues pertaining to airway management in these
cases: the use of supraglottic airway devices and the techniques of, and technical
issues related to, SAGFBI. We also discuss the factors involved in the decision-making
process as to whether to proceed with surgery with the airway maintained only with
a supraglottic airway device, or to proceed only after SAGFBI.
Keywords
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Article info
Publication history
Published online: November 18, 2019
Accepted:
November 5,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
