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”.
Highlights
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
Most anesthetic related maternal deaths still result from complications of airway management during general anesthesia (GA) [13]
The face mask was exchanged for a Patil-Syracuse endoscopic mask {Anesthesia Associates, San Marcos, California}, the proximal end of the esophageal tube was delivered thru the endoscopic port and mask ventilation was attempted with 100% oxygen
Summary
Inability to obtain airway access during emergency Caesarean section (C section) has always been a challenging problem confronting Anesthesiologists. Most anesthetic related maternal deaths still result from complications of airway management during general anesthesia (GA) [13]. The declining use of GA in the obstetric population has raised concern that safety standards may be compromised as a result of inadequate exposure to this technique and insufficient training in airway management for the OPEN ACCESS. While a well established difficult airway management algorithm exists, the time spent on going down the steps might be an unaffordable luxury during maternal and fetal emergencies. Our management one such emergency is detailed in this case report
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