Bullough A S, Carraretto M
Department of Anaesthesia, Great Western Hospitals NHS Foundation Trust, Swindon Wiltshire, UK.
Int J Obstet Anesth. 2009 Oct;18(4):342-5. doi: 10.1016/j.ijoa.2009.01.015. Epub 2009 Jul 21.
Failed intubation is relatively common in the obstetric patient. Overall, there has been a decline in experience of general anaesthesia in obstetrics. The level of anaesthetic preparedness in the event of a difficult obstetric intubation is unknown.
With approval from the Obstetric Anaesthetists' Association, a national postal survey of obstetric units in the United Kingdom was conducted. The survey addressed airway equipment availability and existence of difficult airway algorithms and formal difficult airway drills. The number of deliveries, general anaesthetic cases and failed intubations in each unit was also ascertained.
One hundred and eighty-seven units completed the national obstetric intubation equipment survey questionnaire (78% response rate). All obstetric units possessed a laryngoscope with a normal handle and adult Macintosh blade, a bougie and a laryngeal mask airway. A 7.0 internal diameter endotracheal tube was most often used for securing the airway, and 90% of units stored all airway equipment on a designated difficult airway trolley. A fiberoptic bronchoscope was not readily available and on average it would take >10 min to obtain. A failed intubation incidence of 1:309 was reported. Only one third of units promoted difficult airway training.
Essential airway equipment was readily available in the event of a difficult obstetric intubation, with the exception of a fiberoptic bronchoscope. Few units conduct difficult airway training.
产科患者插管失败相对常见。总体而言,产科全身麻醉的经验有所下降。在困难产科插管情况下的麻醉准备水平尚不清楚。
经产科麻醉医师协会批准,对英国的产科单位进行了一项全国性邮寄调查。该调查涉及气道设备的可用性、困难气道算法的存在情况以及正式的困难气道演练。还确定了每个单位的分娩数量、全身麻醉病例数和插管失败数。
187个单位完成了全国产科插管设备调查问卷(回复率78%)。所有产科单位都拥有带普通手柄和成人麦金托什叶片的喉镜、探条和喉罩气道。内径7.0的气管导管最常用于确保气道安全,90%的单位将所有气道设备存放在指定的困难气道推车上。纤维支气管镜不易获得,平均需要超过10分钟才能拿到。报告的插管失败发生率为1:309。只有三分之一的单位开展困难气道培训。
除纤维支气管镜外,在困难产科插管情况下基本气道设备随时可用。很少有单位进行困难气道培训。