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.

Keywords

rapid-sequence intubation - videolaryngoscope - left-lateral tilt position - premature placental abruption

• References

• 1 Tyner JE, Rayburn WF. Emergency cesarean delivery: special precautions. Obstet Gynecol Clin North Am 2013; 40 (1) 37-45
• 2 McDonnell NJ, Paech MJ, Clavisi OM, Scott KL ; ANZCA Trials Group. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth 2008; 17 (4) 292-297
• 3 Bamber JH, Dresner M. Aortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output. Anesth Analg 2003; 97 (1) 256-258
• 4 Djabatey EA, Barclay PM. Difficult and failed intubation in 3430 obstetric general anaesthetics. Anaesthesia 2009; 64 (11) 1168-1171
• 5 Vanden Hoek TL, Morrison LJ, Shuster M , et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (18) (Suppl. 03) S829-S861
• 6 Asai T, Liu EH, Matsumoto S , et al. Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology 2009; 110 (4) 898-904
• 7 Suzuki A, Toyama Y, Katsumi N , et al. The Pentax-AWS((R)) rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia 2008; 63 (6) 641-647
• 8 Komasawa N, Ueki R, Nomura H, Itani M, Kaminoh Y. Comparison of tracheal intubation by the Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study. J Anesth 2010; 24 (2) 306-308
• 9 Komasawa N, Ueki R, Itani M, Nomura H, Nishi SI, Kaminoh Y. Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study. J Anesth 2010; 24 (6) 908-912
• 10 Asai T. Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikin. Anaesthesia 2009; 64 (10) 1114-1117
• 11 Komasawa N, Ueki R, Itani M, Nishi S, Kaminoh Y. Validation of the Pentax-AWS Airwayscope utility as an intubation device during cardiopulmonary resuscitation on the ground. J Anesth 2010; 24 (4) 582-586
• 12 Hirabayashi Y, Seo N. Tracheal intubation by non-anesthesia residents using the Pentax-AWS airway scope and Macintosh laryngoscope. J Clin Anesth 2009; 21 (4) 268-271
• 13 Kariya N, Kimura K, Iwasaki R, Ueki R, Tatara T, Tashiro C. Intraoperative awake tracheal intubation using the Airway Scope™ in caesarean section. Anaesth Intensive Care 2013; 41 (3) 390-392
• 14 Kohama H, Komasawa N, Ueki R , et al. Utility of the Pentax-AWS Airwayscope and Macintosh laryngoscope for airway management during chest compressions in 27° left-lateral tilt: a manikin simulation study of maternal cardiopulmonary resuscitation. J Anesth 2013; 27 (5) 671-675
• 15 Lipman S, Cohen S, Einav S , et al; Society for Obstetric Anesthesia and Perinatology. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg 2014; 118 (5) 1003-1016
• 16 Nishikawa K, Matsuoka H, Saito S. Tracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope. J Neurosurg Anesthesiol 2009; 21 (4) 292-296