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Difficult intubation in pregnancy

Biro, Peter

Current Opinion in Anesthesiology: June 2011 - Volume 24 - Issue 3 - p 249–254
doi: 10.1097/ACO.0b013e328345ace3
Obstetric and gynecological anesthesia: Edited by Giorgio Capogna

Purpose of review This review focuses on difficult intubation in pregnant patients, particularly during the late pregnancy when physiological, patho-physiological and psychological factors may cause or aggravate difficulties with providing sufficient oxygenation and securing the airway. It is intended to highlight the methodological approach to the difficult airway in this particular patient population and to draw relevant principles in dealing with this problem.

Recent findings There are strong indications for improvement in the outcome of airway management in pregnant patients; however, this is obscured by the growing frequency of caesarean sections and connected to this by more tracheal intubations. Various new airway devices have been suggested as alternative techniques for laryngoscopic intubation if the latter becomes difficult or failed.

Summary A scenario-oriented approach to the problem of difficult intubation in pregnant patients leads to the recognition of the unpredicted difficult or failed intubation as the main concern. The appropriate means to cope with this rare but life-threatening complication lies in a gradual employment of principles beginning with preferential application of regional anaesthesia techniques, followed by proceeding according to locally adapted simple and comprehensive failed intubation algorithms, design of a suitable difficult airway cart that contains only a few but well chosen items and by implementation of a continuous and mandatory training program to which all personnel are subjected to participate in regular intervals.

Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland

Correspondence to PD Dr med. Peter Biro, MD, DESA, Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland Tel: +41 44 2551111; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.