Choice of Anaesthesia for Category-1 Caesarean Section in Women With Anticipated Difficult Tracheal Intubation: The Use of Decision Analysis
| Autor: | S. H. Halpern, Tiberiu Ezri, Yehuda Ginosar, Y. Cohen, Aaron J Krom, J. P. Miller |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Laryngeal Masks Decision Support Techniques Fibreoptic intubation 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Intubation Intratracheal Fetal distress Anesthesia Obstetrical Fiber Optic Technology Humans Medicine General anaesthesia Caesarean section Laryngoscopy Cesarean Section business.industry Tracheal intubation 030208 emergency & critical care medicine medicine.disease Rapid sequence induction Surgery Anesthesiology and Pain Medicine Anesthesia Female Extended time business Airway Decision analysis |
| Zdroj: | Obstetric Anesthesia Digest. 37:215-217 |
| ISSN: | 0275-665X |
| DOI: | 10.1097/01.aoa.0000527059.58659.ad |
| Popis: | Summary A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia. Our results show a shorter mean (95% CI) time to induction of 100 (87–114) s using rapid sequence induction compared with 9 (7–11) min for awake fibreoptic intubation (p < 0.0001) and 6.3 (5.4–7.2) min for spinal anaesthesia (p < 0.0001). We calculate the risk of ultimate failed airway control after rapid sequence induction to be 21 (0–53) per 100,000 cases, and postulate that some mothers may accept such a risk in order to reduce potential fetal harm from an extended time interval until delivery. Although rapid sequence induction may not be the anaesthetic technique of choice for all cases in the circumstance of a category-1 caesarean section for fetal distress with a predicted difficult airway, we suggest that it is an acceptable option. |
| Databáze: | OpenAIRE |
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