• SinaiYitzhak BrzezinskiYBDivision of Anaesthesia, Pain, Critical Care, Tel Aviv Sourasky Medical Centre Affiliated with the Faculty of Medicine, Tel Aviv University, Israel. Electronic address: isaac.sinai@gmail.com., Eleni Anna Papadimitraki, Victor Rabkin, Chen Arviv, Boris Aptekman, Idit Matot, and Carolyn Fiona Weiniger.
• Division of Anaesthesia, Pain, Critical Care, Tel Aviv Sourasky Medical Centre Affiliated with the Faculty of Medicine, Tel Aviv University, Israel. Electronic address: isaac.sinai@gmail.com.
• Int J Obstet Anesth. 2024 Nov 1; 60: 104264104264.

BackgroundThe use of general anaesthesia (GA) for caesarean delivery (CD) introduces the risk of both difficult and failed intubation. Various strategies may be utilised to reduce this risk; however, not all are supported by evidence. We analysed the rate of difficult intubation following implementation of three recommendations specific to airway management in CD.MethodsThis was a retrospective single-center study of CD cases performed under GA at a tertiary care center between January 2013 and December 2022. Cases with GA induced after delivery or with incomplete airway management records were not included in the analysis. We compared outcomes for cases before (2013-2018) versus after (2019-2022) implementation of three specific recommendations: (1) video laryngoscopy (VL) for the first intubation attempt; (2) the presence of a second anesthetist; (3) use of endotracheal tube size 6.5 mm. The primary outcome was difficult intubation, defined as a composite variable (> 1 intubation attempt, use of a rescue device, SpO2 < 90%). We conducted univariable and adjusted analyses of plausible variables associated with difficult intubation, including age, body mass index, predicted difficult airway, and each of three recommendations.ResultsWe identified 1462 cases, 922 before and 540 after implementation. The frequency of difficult intubation was similar with 239 (25.9%) before versus 135 (25.0%) after implementation (p = 0.71; 95% CI -0.03 to 0.05). The recommendations were not associated with a decreased likelihood of difficult intubation in the univariable and adjusted models. Adoption of all three recommendations was significantly more frequent in the post-implementation period.ConclusionImplementation of standardised airway management recommendations had no significant impact on difficult intubation rate, though adoption of all three recommendations was not universal.Copyright © 2024 Elsevier Ltd. All rights reserved.

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