CLINICAL CASES Free access

Minerva Anestesiologica 2002 October;68(10):775-81

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Fibreoptic awake intubation for caesarean section in a parturient with predicted difficult airway

Trevisan P.

Anaesthesia and Resuscitation Operative Unit General Hospital, Feltre (Belluno)

Anaesthetic man­age­ment of a par­tur­i­ent ­with pre­dict­ed dif­fi­cult air­way pre­sent­ing for cae­sar­e­an sec­tion (CS) is not a straight­for­ward deci­sion: gen­er­al anaesthe­sia ­should be avoid­ed ­because intu­ba­tion can be impos­sible and a “can­not intu­bate, can­not ven­ti­late” sce­nar­io ­might ­ensue, on the oth­er ­hand region­al tech­niques can be unsuc­cess­ful or, ­though rare­ly, ­have com­pli­ca­tions ­that ­require emer­gen­cy intu­ba­tion. The ­case is pre­sent­ed of a prim­i­grav­i­da admit­ted to hos­pi­tal at 37 ­weeks’ ges­ta­tion ­with hyper­ten­sion, intra­ute­rine ­growth retar­da­tion and oli­go­hy­dram­ni­os. After a few ­days’ obser­va­tion, it was decid­ed to pro­ceed ­with an elec­tive CS. The pre­op­er­a­tive air­way exam­ina­tion ­revealed a ­poor ­mouth open­ing ­with an inter­den­tal dis­tance of 20 mm and a Mallampati ­class IV. The ­patient was clas­si­fied as a ­case of dif­fi­cult intu­ba­tion and the fol­low­ing anaesthet­ic ­options ­were con­sid­ered: epi­du­ral anaesthe­sia, spi­nal anaesthe­sia and ­awake fib­re­op­tic intu­ba­tion fol­lowed by gen­er­al anaesthe­sia. The ­pros and the ­cons of ­these tech­niques ­were ­explained to the ­patient and it was sug­gest­ed ­that ­awake fib­re­op­tic intu­ba­tion was the saf­est ­option. The ­patient ­gave her con­sent, so an unevent­ful ­nasal ­awake fib­re­op­tic intu­ba­tion was car­ried ­out under ­local anaesthe­sia. This ­case ­report ­offers the oppor­tu­nity to under­line the ­risk to per­form a cen­tral block­ade in a par­tur­i­ent ­with pre­dict­ed dif­fi­cult intu­ba­tion, ­arguing ­that the saf­est ­course of ­action is an ­awake fib­res­cop­ic intu­ba­tion, ­besides ­some con­tro­ver­sial ­points to safe­ly per­form ­awake fib­re­op­tic intu­ba­tion in obstet­ric ­patients are disc­ussed.