Successful Surgical Cricothyroidotomy Following an Obstetric “Can’t Oxygenate” Scenario: A Narrative of Enabling Factors

Abstract

(Int J Obstet Anesth. 2023;53:103611) This report involves a case of failed intubation during general anesthesia (GA) during cesarean delivery (CD) followed by a successful surgical cricothyroidotomy and discusses technical and nontechnical factors. A 40 y/o, G3P1 at 28+3 weeks of gestation with blood pressure of 150/100 mm Hg was diagnosed with pre-eclampsia and admitted to the hospital. At 29+0 weeks gestation, the patient reported chest and abdominal pain. Blood pressure readings were 200/120 mm Hg. The patient received oral labetalol, intravenous magnesium, and oral nifedipine. Blood pressure dropped to 146/78 mm Hg, and labs showed normal platelet count and hemoglobin concentration yet slightly elevated alanine aminotransferase and alkaline phosphatase. Five hours later, when a CD was done for fetal indications, the patient’s platelet count was 50×109/L, so the CD was performed under GA.