Failed intubation in obstetrics

Failed intubation in obstetrics is rare. However, if the situation is not managed appropriately the consequences for the mother and newborn may be catastrophic. The skill of managing the airway seems to be decreasing, primarily because the skills are not being practised in general or obstetric anaesthesia. Solutions for this decrease in skills may include improved training and the use of manikins, both for role play and for practising skills. The priority of airway management is to provide oxygen to the mother and to call for assistance. Oxygen can be provided using basic airway, intubation, and, if necessary, surgical airway skills. Such skills need to be practised on manikins and non-obstetric patients. The decreasing incidence of general anaesthetics means that planning and preparation should be meticulous before and during caesarean section. Ideally, the first intubation attempt should be the best. If a failed intubation occurs, initially techniques such as the use of a bougie, McCoy blade or the left molar approach may be considered, provided hypoxia is avoided. If intubation is unsuccessful the mother should be woken and a regional technique or awake fibreoptic intubation from a suitably experienced practitioner should be considered. A simple protocol shown in this article can be used as a training tool to assess skills, decision-making and teamwork in the event of a failed intubation. Extubation after a difficult intubation should be done with care, and the patient warned of the difficulty in case of further anaesthetics.