EditorOver the years, airway problems have dominated anaesthesia related maternal mortality. Failed intubation in parturients is more common than the general surgical population with incidences in the obstetric population being as high as 1 in 250.1 2 We report our local experience.
As a part of an ongoing audit we collect data about failed intubation and these, with other data, are recorded in the annual hospital report. We analysed the data for the 16 yr from 1988 to 2004. During this period, 91 758 women gave birth in our institution. Of these, 19 600 were delivered by Caesarean section (CS) either electively or as an emergency. Though the annual number of CS increased from 984 in 1988 to 1531 in 200304, in keeping with national practice,3 the numbers performed under general anaesthesia decreased from 644 to 235 in the same years. There were 11 failed intubations during this period in 5968 general anaesthetics administered for CS giving an incidence of 1 in 543 (Table 1). There were no failed intubations in general anaesthetics administered for other purposes in parturients. We split our data into before and after the introduction of Calman training in 1996. Though the incidence of failed intubation increased from 1 in 770 (198895) to 1 in 353 (19962004), these data are not statistically significant (2-test). There was no mortality related to airway problems during this period. On four occasions a laryngeal mask airway (LMA®)
was documented as being used successfully, three times since 1996.
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Birmingham, UK
Footnotes
LMA® is the property of Intavent Ltd.
References
1 Barnardo PD, Jenkins JG. Failed tracheal intubation in obstetrics: a 6 year review in a UK region. Anaesthesia 2000; 55: 68594[CrossRef][ISI][Medline]
2 Hawthorne L, Wilson R, Lyons G, Dresner M. Failed intubation revisited: 17 yr experience in a teaching maternity unit. Br J Anaesth 1996; 76: 6804
3 NHS Maternity Statistics, England: 200203. Bulletin 10; Government Statistical Services, Department of Health, 2004
4 Johnson RV, Lyons GR, Wilson C, Robinson APC. Training in obstetric general anaesthesia: a vanishing art? Anaesthesia 2000; 55: 16383[CrossRef][ISI][Medline]
5 Goodwin MWP, French GWG. Simulation as a training and assessment tool in the management of failed intubation in obstetrics. Int J Obstet Anesth 2001; 10: 2737[CrossRef][ISI][Medline]