Difficult and failed intubation in obstetric anaesthesia

Abstract

Difficult intubation in obstetric anaesthesia remains an important cause of maternal morbidity and mortality. Recent quoted estimates for difficult intubation vary between 1:19 and 1:49 whilst for failed intubation they vary between 1:180 and 1:808. Physiological changes during pregnancy, low general anaesthesia (GA) rates in obstetrics contributing to limited training opportunities, increased obstetric activity performed out-of-hours, a time-pressure environment, isolated location, and obstetric emergencies for which a GA is often utilized are cited contributing to difficult and failed intubation in obstetrics. Human factors often contribute to most situations in difficult and failed intubations. Recent studies seem to highlight that the majority of risk factors contributing to difficult or failed intubation in obstetrics are non-obstetric in nature. Propofol use during GA in obstetric surgery has been associated with a lower risk of difficult intubation. The joint Difficult Airway Society (DAS) and Obstetric Anaesthetists’ Association (OAA) guidelines offer a structured algorithmic approach with decision-making tools to enhance safety. Key strategies include understanding contributing factors, thorough preoperative assessment, planning, good communication and multidisciplinary training and simulation. Adherence to these guidelines is crucial for reducing the maternal and fetal morbidity from difficult or failed intubation during obstetric general anaesthesia.