All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

Ramkumar, Venkateswaran and Ekambaram, Dinesh and Shetty, Sumalatha Radhakrishna (2016) All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. Indian Journal of Anaesthesia, 60 (12). pp. 899-898. ISSN 0019-5049

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The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid ressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreopticguided intubation via the SAD or wake up the patient depends on the urgency of surgery, foetomaternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.

Item Type: Article
Uncontrolled Keywords: Cricoid pressure; difficult airway; face mask ventilation; failed intubation; high‑flow nasal cannula; intubation; modified rapid sequence induction; obstetrics ; parturient ; perimortem caesarean delivery; preoxygenation.
Subjects: Medicine > KMC Manipal > Anaesthesiology
Depositing User: KMC Library
Date Deposited: 13 Mar 2017 04:51
Last Modified: 13 Mar 2017 04:51

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