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LETTER TO THE EDITOR
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 53

Video laryngoscopy in obstetric anesthesia


Department of Anaesthesia and Critical Care, Northwick Park Hospital, London, United Kingdom

Date of Web Publication4-Aug-2012

Correspondence Address:
Adam Shonfeld
Northwick Park Hospital, Watford Road, HARROW, HA1 3UJ, London
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.99330

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How to cite this article:
Shonfeld A, Gray K, Lucas N, Robinson N, Loughnan B, Morris H, Rao K, Vaughan D. Video laryngoscopy in obstetric anesthesia. J Obstet Anaesth Crit Care 2012;2:53

How to cite this URL:
Shonfeld A, Gray K, Lucas N, Robinson N, Loughnan B, Morris H, Rao K, Vaughan D. Video laryngoscopy in obstetric anesthesia. J Obstet Anaesth Crit Care [serial online] 2012 [cited 2021 May 10];2:53. Available from: https://www.joacc.com/text.asp?2012/2/1/53/99330

Sir,

We wish to report a case series of video laryngoscopy in obstetric patients undergoing general anesthesia. The risk of difficult or failed intubation for parturients has historically been higher than for non-pregnant patients. [1],[2],[3] Failed intubation in obstetrics continues to be a major source of worry for all grades of obstetric anesthetist. Video laryngoscopy has been shown to aid intubation by giving a better view of the glottis in both predicted and unpredicted difficult intubation by preventing the need to align pharyngeal and laryngeal axis'. [4]

We recorded data for 27 patients requiring general anesthesia for caesarean section.

The cases were a mixture of categories of urgency of caesarean section - category 1 (7 cases), category 2 (7 cases), category 3 (2 cases), and category 4 (11 cases). Classified using the category system devised by Lucas et al. [5] - (1) immediate threat to life of woman or fetus; (2) maternal or fetal compromise which is not immediately life threatening; (3) needing early delivery but no maternal or fetal compromise; (4) at a time to suit the patient and maternity team.

Following rapid sequence induction, traditional direct laryngoscopy was performed using a video laryngoscope (Storz C-MAC); intubation was then performed using the image on the screen of the video laryngoscope. The Storz C-MAC laryngoscope blade is the same shape as a standard Macintosh laryngoscope blade and comparable direct laryngoscopy view will be achieved with both. The anesthetists were asked to record the direct Cormack and Lehane grade, the view on the video laryngoscope (given a Cormack and Lehane grade as if it were seen directly) and any aids used for intubation [Table 1].
Table1: Cormack and Lehane views comparing standard Laryngoscopic and video laryngoscopic views

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Video laryngoscopy has not been previously studied in parturients and we found that the Cormack and Lehane grades observed were better on the video laryngoscope view than direct laryngoscopy. All patients were successfully intubated and no patients' oxygen saturation level fell below 94%.

In this observational series, our numbers are too low for statistical analysis, but our findings suggest that video laryngoscopy presents a better laryngoscopic view in this group of patients. In addition, the majority of the intubations (78%) were performed by anesthetists with limited previous use of video laryngoscopy (<20 uses). Previous work has shown that video laryngoscopy can be used successfully by anesthetists with minimal prior experience. [6] We believe that the video laryngoscope has a place in obstetric theatre as part of the available difficult airway equipment.

 
  References Top

1.Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.  Back to cited text no. 1
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2.Marx GF, Finster M. Difficulty in endotracheal intubation associated with obstetric anesthesia (Letter). Anesthesiology 1975;51:364-5.  Back to cited text no. 2
    
3.Rocke DA, Murray WB, Rout CC, Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology 1992;77:67-73.  Back to cited text no. 3
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4.Kaplan MB, Berci G. Videolaryngoscopy in the management of the difficult airway. Can J Anaesth 2004;51:94.  Back to cited text no. 4
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5.Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, et al. Urgency of caesarean section: A new classification. J R Soc Med 2000;93:346-50.  Back to cited text no. 5
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6.Rope TC, Loughnan BA, Vaughan DJ. Videolaryngoscopy -An answer to difficult laryngoscopy? Eur J Anaesthesiol 2008;25:434-5.  Back to cited text no. 6
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    Tables

  [Table 1]


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3 Obstetric Anaesthetistsę Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics
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