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Airway changes during Cesarean hysterectomy
K Bhavani-Shankar1, E P Lynch, S Datta
1Department of Anaesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. bhavani@capnography.com
Purpose:
To document whether hemorrhage and fluid administration during peripartum hysterectomy results in changes in the airway that may predispose to subsequent difficult intubation, in the event that intraoperative general anesthesia is required during regional anesthesia.
Clinical Features:
A 32-yr-old underwent peripartum hysterectomy for placenta accreta. Blood loss of 5.5 L occurred during surgery requiring 6 L crystalloid, 1 L hetastarch, five units packed RBCs and two units fresh frozen plasma. Airway changes were followed using Samsoon's modification of Mallampati airway classification. In addition, airway photographs were obtained using a Polaroid camera. The airway of the patient changed from class 2 preoperatively to class 4 in the immediate postoperative period. The airway gradually returned to normal over the ensuing 48 hr, during which a negative fluid balance of 4 L occurred due to substantial postoperative diuresis.
Conclusion:
Peripartum airway changes were detected during Cesarean hysterectomy and fluid resuscitation that gradually returned to normal within 48 hr after surgery.