Airway management and training in obstetric anaesthesia

Airway management and failed intubation in the pregnant woman requires unique considerations, which differ from the nonpregnant patient. Factors that influence airway management in this setting include anatomical and physiological changes in pregnancy, environmental factors as well as training matters. In addition, surgery is often being performed with extreme urgency, which requires rapid decision-making process that takes into account safe outcome of mother and baby. The purpose of this review is to focus on recent developments that address these exceptional airway challenges in obstetrics.

The first national UK obstetric difficult airway guidelines that have been recently published, are based around algorithms that deal with induction of general anaesthesia, failed intubation and front-of-the-neck access. As well as emphasising good practice in planning, preparation, and rapid sequence induction (RSI) technique, they outline how to make a provisional plan prior to the induction of general anaesthesia, on whether to awaken or continue general anaesthesia, should failed intubation occur. Current recommendations aim to move away from the traditional and outdated obstetric RSI technique to introduce changes, which are in keeping with anaesthetic practice in the nonpregnant patients. Such changes include the choice of induction agent and muscle relaxant, preoxygenation techniques, and mask ventilation during RSI; and the early release of cricoid pressure should failed intubation occur.

Recent advances and recommendations in the management of the obstetric airway should help to bring consistency of clinical practice, reduce adverse events, and standardize teaching by providing a structure for teaching and training on failed tracheal intubation in obstetrics. Opportunities during elective caesarean sections and simulation should be used as teaching tools to improve anaesthetists' and team performance during a crisis.