title: Adverse airway events in parturient compared with non-parturient patients. Is there a difference? Results from a quality management project.
abstract: OBJECTIVE
  The fear of airway problems often leads to prolonged attempts to obtain neuroaxial (spinal anesthesia or epidural anesthesia) anesthesia in obstetric anesthesia. The aim of this institutional quality management study was to revisit existing anesthesia care in the obstetric department, focusing on the frequency of delayed or failed neuroaxial anesthesia as well as the risk of airway problems in parturient and non-obstetric patients.
  
  
  METHODS
  The clinical records from 8 consecutive years (2005-2013) were analyzed retrospectively. Cases of cesarean delivery with general anesthesia were analyzed and compared with an age-matched group of female patients undergoing non-obstetric abdominal or gynecological surgery with rapid sequence induction. Poor laryngeal visualization (Cormack-Lehane grade III or IV) and failed intubation were recorded.
  
  
  RESULTS
  The records of 6393 cesarean deliveries including 851 with general anesthesia were analyzed. In 175 cases insufficient or delayed onset of regional anesthesia led to requirement for general anesthesia. The rate of poor laryngoscopic view in parturient women undergoing cesarean delivery was 14/851, and 4/814 in the reference group (P = 0.023). Failed intubation occurred in three patients undergoing cesarean delivery (0.4%) and in one non-obstetric patient (0.1%; P = 0.339).
  
  
  CONCLUSIONS
  The rate of failed intubations in patients undergoing cesarean delivery may be equivalent to non-obstetric patients. In time-challenging cesarean deliveries, delay of conversion from non-successful neuroaxial anesthesia to general anesthesia in order to avoid adverse airway events does not appear to be justified.
authors.affiliation: Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heinrich
authors.affiliation: Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Irouschek
authors.affiliation: Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Prottengeier
authors.affiliation: Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ackermann
authors.affiliation: Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology*; D000768:Anesthesia, General / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D000068240:Data Anonymization; D057286:Electronic Health Records; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011247:Pregnancy; D011787:Quality of Health Care; D012137:Respiratory System / Q000293:injuries* / Q000503:physiopathology; D012189:Retrospective Studies; D012306:Risk
keywords: adverse airway event; difficult airway; emergency cesarean delivery; obstetric anesthesia; poor laryngoscopic view