Summary by Jeffery Cannon MD, 2/21/22
https://pubmed.ncbi.nlm.nih.gov/18617389/

Below is a great summary of an observational study (n=1095) from theInternational Journal of Obstetric Anesthesia (2009) on airway management and complications associated with general anesthesia for caesarean section.

Take Home Points: 

  • General anesthesia in the parturient is associated with complications mostly related to airway management. Use smaller ETT in pregnant patients, given the airway edema changes of pregnancy.

  • Term Pregnancy in and of itself is a high risk of aspiration and by definition, necessitates a rapid sequence induction, if GA is indicated. In this study, 97% RSI w/ succinylcholine, 2% modified RSI w/ rocuronium. Aspiration prophylaxis is crucial. 

  • LMA is ideal for airway management in difficult airway scenarios, until a more definitive airway could be established. 

    • This is simply true during any difficult airway scenario (ED, OB, OR, ICU, Code situation).

Difficult Intubation in Obstetric Anesthesia