title: Rapid-Sequence Intubation in the Left-Lateral Tilt Position in a Pregnant Woman with Premature Placental Abruption Utilizing a Videolaryngoscope.
abstract: Case A 24-year-old pregnant woman was admitted to our hospital with decreased fetal heart rate. Obstetric examination revealed premature placental abruption; emergent caesarean section was planned under general anesthesia. On entering the operating room, the patient showed severe vital sign deterioration (blood pressure, 75/45 mm Hg; heart rate, 142 beats per minute). As left uterine displacement may worsen the premature placental abruption, the patient was placed in the left-lateral tilt position by rotating the operating table to release compression on the inferior vena cava by theuterus. To avoid circulatory collapse, rapid-sequence intubation was performed in this position. Tracheal intubation was performed with the Pentax-AWS Airwayscope (AWS videolaryngoscope, AWS; HOYA, Japan) to obtain a good laryngeal view and minimize stress from laryngoscopy. After sufficient oxygenation, 120 mg of thiopental was administered. A second anesthesiologist performed cricoid pressure and 50 mg of rocuronium was administered after confirming loss of consciousness. This was followed by insertion of the AWS with a thin intlock into the mouth. Tracheal intubation was performed uneventfully. Discussion Rapid-sequence intubation in the left-lateral tilted position with the AWS videolaryngoscope may be beneficial for pregnant women with vital sign deterioration.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Nakao
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kusaka
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
keywords: left-lateral tilt position; premature placental abruption; rapid-sequence intubation; videolaryngoscope