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To further add to the complexity of airway management in OB patients

The difficulties, morbidity and mortality associated with airway management and obstetrics, lead to a culture shift, and regional anesthesia and specifically neuro-axial blocks are very often used to provide anesthesia in this patient population. This brings an interesting question.How to maintain skills, gain experience and train residents in the dying art of GA in obstetrics? How to assure greater success rates and safety in those rare GA cases? Read on

GA and C-section

7 Responses to “To further add to the complexity of airway management in OB patients”

  1. Dietrich Gravenstein says:

    Tuff question. This is a good example why, just as we have anesthesia specialists for complex congenital heart surgery – rare problem that not everyone can be expected to be expert at – there is reason to have complex airway specialists. How to train such individuals is something the Board also needs to address as there are no actual airway management credentialing requirements, or even recommendations for that matter. Clearly, if one limits their clinical exposure to the OB suites, one will over time encounter enough urgent c-sections that should not wait or should not have a regional technique and will allow. But the service will need to be of sufficient volume to allow mastery of the required skills without them erroding from too little or only sporadic use. For those who need to develop experience in the OR, our bariatric surgery patients, perhaps with a little histamine release thrown in for good measure, are the next closest analogs to our OB patients. Encourage everyone to go back for seconds!

  2. Felipe Urdaneta says:

    I also think that simulation can help a lot too. Knowing that as good and realistic as they are now, simulators are not as realistic or frightening as having a 300 pounder with a prolapse cord and a yelling obstetrician with RN’s running like atomic particles; but at least it can make you have a plan ahead to prepare for the real thing. BTW I do not mean the comment of the 300 pounder in a negative fashion. I know that in the world and specially the US there are a lot of people that you can love pound per pound 🙂

  3. Tyson Ulmer says:

    The article mentions a McCoy blade. What is that?
    Here is a link to an explanation:

    I suppose the next question to the authors would be, of the quoted 50 maternal deaths due to lost airway, what happened? Why did they fail?

  4. William Smith says:

    It would be more helpful in the article if they would have presented more statistics regarding their patient population, especially with them not having a single failed intubation within the study. They do mention overweight patients and that 2 of had a BMI >35 (for an average 5’4″ women, all you have to be to hit that number is 205 lbs), but on an average week at Shands or VA (which sadly probably gives an accurate representation of our population as a whole) we encounter that fairly frequently. With the overall increase in our patient’s dimensions, all of our intubation skills should continue to improve.

  5. Felipe Urdaneta says:

    But the main point of the article is to raise the alarm that in OB since GA is seldom used -usually only during emergencies-, keeping up the skills or training house-officers to become good at it, is difficult. It would be great to know how many GA’s for C-sections our residents as average do?

  6. Felipe Urdaneta says:

    NG wrote:
    In america ga for cs is rare. Thus we can’t practice since it wouldn’t be tolerated to do ga. It is reassuring that they don’t have troubles but the uk bmi profile might be much lower than ours. Also they are willing to do awake airway when they are concerned . No idea why they wouldn’t do a spinal for such a cs since it must be faster than an awake intubation

  7. Felipe Urdaneta says:

    But I think the point they are trying to make is that it is concerning how because GA -as you say- is very rare, we are not practicing the handling to the risky emergent obstetric airway; if we are faced with an emergency OB case, chances are we are no better than we were years back. I think we need to practice and be prepared for GA because inevitably we will face situations when RA would not work, there would not be enough time or there will be a contraindication for it, or when we will have for example a total spinal.


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