TITLE:
Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach
AUTHORS:
Ramasamy Govindarajan, Christopher Chang, Wesam Khalil, Noemi Balogh, Elizabeth Cole England, Saiganesh Ravikumar
KEYWORDS:
Unanticipated Difficult Airway; Emergency C Section; Glidescope Assisted Fiberoptic Intubation; Difficult Airway Algorithm
JOURNAL NAME:
Surgical Science,
Vol.5 No.1,
January
24,
2014
ABSTRACT: Introduction: Knowledge,
skill and training in addition to quick thinking, come to the rescue of
Anesthesiologists when encountering an unanticipated difficult airway during
emergency Caesarean section. Ability to react with time to spare will ensure
maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean
section, the endotracheal tube was inadvertently placed in the esophagus. As
the “call for help” was activated, the esophageal tube was
delivered thru the endoscopic port of a Patil-Syracuse face mask. After
confirming our ability to ventilate the patient without distending the stomach
while maintaining the oxygen saturation and end tidal carbon dioxide levels
within normal limits, surgery was allowed to proceed under mask anesthesia
employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle
relaxation. After a healthy infant was delivered, definitive airway access was
obtained with Glidescope? assisted fiberoptic intubation. The
esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal
end of the inadvertently placed esophageal tube thru the endoscopic port of a
Patil-Syracuse mask and mask ventilating the patient, we have been able to
provide that few precious minutes of oxygenation to the distressed fetus before
delivery. By isolating and venting the stomach thru the esophageal tube we
provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon
as additional help and equipment were available. Conclusion: Difficult
airway algorithm while comprehensive, does not address the question of time
management. While dealing with a difficult airway in obstetric anesthesia, time
is the single most important factor, which will determine the maternal and
fetal well being. We in our case report have attempted to answer that question
of “time”.