AJP Rep 2015; 05(01): e30-e32
DOI: 10.1055/s-0034-1544109
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rapid-Sequence Intubation in the Left-Lateral Tilt Position in a Pregnant Woman with Premature Placental Abruption Utilizing a Videolaryngoscope

Kenta Nakao
1  Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
,
Nobuyasu Komasawa
1  Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
,
Yusuke Kusaka
1  Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
,
Toshiaki Minami
1  Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
› Author Affiliations
Further Information

Publication History

27 September 2014

28 November 2014

Publication Date:
25 February 2015 (eFirst)

  

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.