Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics

M C Mushambi, S M Kinsella, M Popat, H Swales, K K Ramaswamy, A L Winton, A C Quinn, Obstetric Anaesthetists' Association, Difficult Airway Society, M C Mushambi, S M Kinsella, M Popat, H Swales, K K Ramaswamy, A L Winton, A C Quinn, Obstetric Anaesthetists' Association, Difficult Airway Society

Abstract

The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

© 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Figures

Figure 1
Figure 1
Master algorithm – obstetric general anaesthesia and failed intubation. The yellow diamond represents a decision-making step. Pmax, maximal inflation pressure; CICO, ‘can't intubate, can't oxygenate’. The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.
Figure 2
Figure 2
Algorithm 1 – safe obstetric general anaesthesia. WHO, World Health Organization; FETO2, end-tidal fraction of oxygen; Pmax, maximal inflation pressure. The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.
Figure 3
Figure 3
Table 1 – wake or proceed with surgery? Criteria to be used in the decision to wake or proceed following failed tracheal intubation. In any individual patient, some factors may suggest waking and others proceeding. The final decision will depend on the anaesthetist's clinical judgement. The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.
Figure 4
Figure 4
Algorithm 2 – obstetric failed tracheal intubation. The yellow diamonds represent decision-making steps; the lower right decision step links to Table 1 (Fig.3). The boxes at the bottom link to Table 2 (Fig 6). The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.
Figure 5
Figure 5
Algorithm 3 – ‘can't intubate, can't oxygenate’. The yellow diamonds represent decision-making steps; the lower right decision step links to Table 1 (Fig.3). The boxes at the bottom link to Table 2 (Fig. 6). ENT, ear, nose and throat. The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.
Figure 6
Figure 6
Table 2 – management after failed tracheal intubation. i.v., intravenous. The algorithms and tables are reproduced with permission from the OAA and DAS and are available online in pdf and PowerPoint formats.

References

    1. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004;59:675–94.
    1. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice Guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.
    1. American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106:843–63.
    1. Law JA, Broemling N, Cooper RM, et al. The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient. Canadian Journal of Anesthesia. 2013;60:1089–118.
    1. Law JA, Broemling N, Cooper RM, et al. The difficult airway with recommendations for management – Part 1– The anticipated difficult airway. Canadian Journal of Anesthesia. 2013;60:1119–38.
    1. Petrini F, Accorsi A, Adrario E, et al. Recommendations for airway control and difficult airway management. Minerva Anestesiologica. 2005;71:617–57.
    1. Obstetric Anaesthetists' Association. Clinical Guidelines: failed intubation (accessed 19/07/2015)
    1. Searle RD, Lyons G. Vanishing experience in training for obstetric general anaesthesia: an observational study. International Journal of Obstetric Anesthesia. 2008;17:233–7.
    1. Kinsella SM, Winton ALS, Mushambi MC, et al. Failed tracheal intubation during obstetric general anaesthesia: a literature review. International Journal of Obstetric Anesthesia. 2015 June 30; doi: . [Epub ahead of print]
    1. Tunstall ME. Failed intubation drill. Anaesthesia. 1976;31:850.
    1. Kinsella SM. Anaesthetic deaths in the CMACE (Centre for Maternal and Child Enquiries) Saving Mothers' lives report 2006-08. Anaesthesia. 2011;66:243–6.
    1. Swales H, Mushambi M, Winton A, et al. Management of failed intubation and difficult airways in UK obstetric units: an OAA survey. International Journal of Obstetric Anesthesia. 2014;23:S19.
    1. Oxford Centre for Evidence-Based Medicine. 2011. The Oxford 2011 Levels of Evidence (accessed 19/07/2015)
    1. Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. British Journal of Anaesthesia. 1995;74:638–42.
    1. Kodali B-S, Chandrasekhar S, Bulich LN, Topulos GP, Datta S. Airway changes during labor and delivery. Anesthesiology. 2008;108:357–62.
    1. Chassard D, Le Quang D. Mallampati score during pregnancy. British Journal of Anaesthesia. 2012;108 S2:ii200.
    1. Bryssine B, Chassard D, Le Quang D. Neck ultrasonography and mallampati scores in pregnant patients. British Journal of Anaesthesia. 2012;108 S2:ii200.
    1. Leboulanger N, Louvet N, Rigouzzo A, et al. Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method. International Journal of Obstetric Anesthesia. 2014;23:35–9.
    1. Heller PJ, Scheider EP, Marx GF. Pharyngolaryngeal edema as a presenting symptom in preeclampsia. Obstetrics and Gynecology. 1983;62:523–5.
    1. O'Connor R, Thorburn J. Acute pharyngolaryngeal oedema in a pre-eclamptic parturient with systemic lupus erythematosus and a recent renal transplant. International Journal of Obstetric Anesthesia. 1993;2:53–5.
    1. Jouppila R, Jouppila P, Hollmen A. Laryngeal oedema as an obstetric anaesthesia complication: case reports. Acta Anaesthesiologica Scandinavica. 1980;24:97–8.
    1. Quinn AC, Milne D, Columb M, Gorton H, Knight M. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case-control study in the UK. British Journal of Anaesthesia. 2013;110:74–80.
    1. Hawthorne L, Wilson R, Lyons G, Dresner M. Failed intubation revisited: 17-yr experience in a teaching maternity unit. British Journal of Anaesthesia. 1996;76:680–4.
    1. Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia. 2005;60:168–71.
    1. Johnson RV, Lyons GR, Wilson RC, Robinson APC. Training in obstetric general anaesthesia: a vanishing art? Anaesthesia. 2000;55:179–83.
    1. Tsen LC, Pitner R, Camann WR. General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications. International Journal of Obstetric Anesthesia. 1998;7:147–52.
    1. Smith NA, Tandel A, Morris RW. Changing patterns in endotracheal intubation for anaesthesia trainees: a retrospective analysis of 80,000 cases over 10 years. Anaesthesia and Intensive Care. 2011;39:585–9.
    1. Yarrow S, Hare J, Robinson KN. Recent trends in tracheal intubation: a retrospective analysis of 97 904 cases. Anaesthesia. 2003;58:1019–22.
    1. Bromiley M. Have you ever made a mistake? Bulletin of the Royal College of Anaesthetists. 2008;48:2442–5.
    1. Clinical Human Factors Group. 2015. What is human factors? (accessed 19/07/2015)
    1. Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care – Lessons Learned to Inform Future Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit; 2014.
    1. McGuire B. Pre-operative airway assessment. In: Colvin JR, Peden C, editors. Raising the Standard: A Compendium of Audit Recipes for Continuous Quality Improvement in Anaesthesia. 3rd edn. London: Royal College of Anaesthetists; 2012. pp. 78–9.
    1. Kuczkowski KM, Benumof JL. Tongue piercing and obstetric anesthesia: is there cause for concern? Journal of Clinical Anesthesia. 2002;14:447–8.
    1. Macfie AG, Magides AD, Richmond MN, Reilly CS. Gastric emptying in pregnancy. British Journal of Anaesthesia. 1991;67:54–7.
    1. Scrutton MJL, Metcalfe GA, Lowy C, Seed PT, O'Sullivan G. Eating in labour. A randomised controlled trial assessing the risks and benefits. Anaesthesia. 1999;54:329–34.
    1. Whitehead EM, Smith M, Dean Y, O'Sullivan G. An evaluation of gastric emptying times in pregnancy and the puerperium. Anaesthesia. 1993;48:53–7.
    1. Association of Anaesthetists of Great Britain and Ireland. Pre-operative Assessment and Patient Preparation. The Role of the Anaesthetist 2. London: AAGBI; 2010.
    1. Schneck H, Scheller M. Acid aspiration prophylaxis and caesarean section. Current Opinion in Anesthesiology. 2000;13:261–5.
    1. Paranjothy S, Griffiths JD, Broughton HK, Gyte GML, Brown HC, Thomas J. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. International Journal of Obstetric Anesthesia. 2011;20:142–8.
    1. National Institute for Health and Care Excellence. Intrapartum care: care of healthy women and their babies during childbirth. CG190, 2014. (accessed 19/07/2015)
    1. Calthorpe N, Lewis M. Acid aspiration prophylaxis in labour: a survey of UK obstetric units. International Journal of Obstetric Anesthesia. 2005;14:300–4.
    1. Thurlow JA, Kinsella SM. Intrauterine resuscitation: active management of fetal distress. International Journal of Obstetric Anesthesia. 2002;11:105–16.
    1. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine. 2009;360:491–9.
    1. Wittenberg MD, Vaughan DJA, Lucas DN. A novel airway checklist for obstetric general anaesthesia. International Journal of Obstetric Anesthesia. 2013;22:264–5.
    1. Royal College of Anaesthetists and Difficult Airway Society. Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4). Major complications of airway management in the UK. Report and findings, 2011. (accessed 19/07/2015)
    1. Thomas J, Paranjothy S. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report. London: RCOG Press; 2001.
    1. Leung TY, Chung PW, Rogers MS, Sahota DS, Lao TT-H, Chung TKH. Urgent cesarean delivery for fetal bradycardia. Obstetrics and Gynecology. 2009;114:1023–8.
    1. Kayani SI, Walkinshaw SA, Preston C. Pregnancy outcome in severe placental abruption. British Journal of Obstetrics and Gynaecology. 2003;110:679–83.
    1. Schmidt WA, Affleck JA, Jacobson S-L. Fatal fetal hemorrhage and placental pathology. Report of three cases and a new setting. Placenta. 2005;26:419–31.
    1. Bujold E, Francoeur D. Neonatal morbidity and decision-delivery interval in patients with uterine rupture. Journal of Obstetrics and Gynaecology Canada. 2005;27:671–3.
    1. Prabulos A-M, Philipson EH. Umbilical cord prolapse: is the time from diagnosis to delivery critical? Journal of Reproductive Medicine. 1998;43:129–32.
    1. Sangwan V, Nanda S, Sangwan M, Malik R, Yadav M. Cord complications: associated risk factors and perinatal outcome. Open Journal of Obstetrics and Gynecology. 2011;1:174–7.
    1. Hignett R, Fernando R, McGlennan A, et al. Does a 30o head-up position in term parturients increase functional residual capacity? Implications for general anaesthesia. International Journal of Obstetric Anesthesia. 2008;17:S5.
    1. Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005;60:1064–7.
    1. Ramkumar V, Umesh G, Philip FA. Preoxygenation with 200 head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. Journal of Anesthesia. 2011;25:189–94.
    1. Altermatt FR, Munoz HR, Delfino AE, Cortinez LI. Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. British Journal of Anaesthesia. 2005;95:706–9.
    1. Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005;102:1110–5.
    1. Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. British Journal of Anaesthesia. 2007;99:581–6.
    1. Vanner R. Cricoid pressure. International Journal of Obstetric Anesthesia. 2009;18:103–5.
    1. Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obesity Surgery. 2004;14:1171–5.
    1. Kuczkowski KM, Benumof JL. Anaesthesia and hair fashion. Anaesthesia. 2001;56:799–800.
    1. Famewo CE. Difficult intubation due to a patient's hair style. Anaesthesia. 1983;38:165–6.
    1. Chikungwa MT. Popular hair style-an anaesthetic nightmare. Anaesthesia. 2000;55:305–6.
    1. Cattano D, Cavallone L. Airway management and patient positioning: a clinical perspective. Anesthesiology News. 2011;8:17–23.
    1. Ashley E, Marshall P. Problems with fashion. Anaesthesia. 2000;55:834.
    1. Russell GN, Smith CL, Snowdon SL, Bryson TH. Pre-oxygenation and the parturient patient. Anaesthesia. 1987;42:346–51.
    1. Russell EC, Wrench I, Feast M, Mohammed F. Pre-oxygenation in pregnancy: the effect of fresh gas flow rates within a circle breathing system. Anaesthesia. 2008;63:833–6.
    1. Rassam S, Stacey M, Morris S. How do you preoxygenate your patient? International Journal of Obstetric Anesthesia. 2005;14:79.
    1. Diacon MJ, Porter R, Wrench IJ. Pre-oxygenation for caesarean section under general anaesthesia. Anaesthesia. 2012;67:563.
    1. McClelland SH, Bogod DG, Hardman JG. Pre-oxygenation in pregnancy: an investigation using physiological modelling. Anaesthesia. 2008;63:259–63.
    1. Hardman JG, Wills JS, Aitkenhead AR. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling. Anesthesia and Analgesia. 2000;90:619–24.
    1. Baraka AS, Taha SK, Siddik-Sayyid SM, et al. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007;62:769–73.
    1. Taha SK, Siddik-Sayyid SM, El-Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique. Anaesthesia. 2006;61:427–30.
    1. Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. Journal of Clinical Anesthesia. 2010;22:164–8.
    1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Annals of Emergency Medicine. 2012;59:165–75.
    1. Patel A, Nouraei SAR. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70:323–9.
    1. El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesthesia and Analgesia. 2010;110:1318–25.
    1. Thwaites AJ, Rice CP, Smith I. Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation. Anaesthesia. 1999;54:376–81.
    1. Benhamou D, Bouaziz H, Chassard D, et al. Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. European Journal of Anaesthesiology. 2009;26:694–700.
    1. Vanner RG, Pryle BJ. Regurgitation and oesophageal rupture with cricoid pressure: a cadaver study. Anaesthesia. 1992;47:732–5.
    1. Palmer JHM, Ball DR. The effect of cricoid pressure on the cricoid cartilage and vocal cords: an endoscopic study in anaesthetised patients. Anaesthesia. 2000;55:263–8.
    1. Hartsilver EL, Vanner RG. Airway obstruction with cricoid pressure. Anaesthesia. 2000;55:208–11.
    1. Taylor RJ, Smurthwaite G, Mehmood I, Kitchen GB, Baker RD. A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure. Anaesthesia. 2015;70:18–25.
    1. Loughnan TE, Gunasekera E, Tan TP. Improving the C-MAC video laryngoscopic view when applying cricoid pressure by allowing access of assistant to the video screen. Anaesthesia and Intensive Care. 2012;40:128–30.
    1. Haslam N, Parker L, Duggan JE. Effect of cricoid pressure on the view at laryngoscopy. Anaesthesia. 2005;60:41–7.
    1. McNelis U, Syndercombe A, Harper I, Duggan J. The effect of cricoid pressure on intubation facilitated by the gum elastic bougie. Anaesthesia. 2007;62:456–9.
    1. Brimacombe J, White A, Berry A. Effect of cricoid pressure on ease of insertion of the laryngeal mask airway. British Journal of Anaesthesia. 1993;71:800–2.
    1. Asai T, Barclay K, Power I, Vaughan RS. Cricoid pressure impedes placement of the laryngeal mask airway. British Journal of Anaesthesia. 1995;74:521–5.
    1. Koerber JP, Roberts GEW, Whitaker R, Thorpe CM. Variation in rapid sequence induction techniques: current practice in Wales. Anaesthesia. 2009;64:54–9.
    1. Stone JP, Fenner LB, Christmas TR. The preparation and storage of anaesthetic drugs for obstetric emergencies: a survey of UK practice. International Journal of Obstetric Anesthesia. 2009;18:242–8.
    1. Murdoch H, Scrutton M, Laxton CH. Choice of anaesthetic agents for caesarean section: a UK survey of current practice. International Journal of Obstetric Anesthesia. 2013;22:31–5.
    1. Rucklidge M. Up-to-date or out-of-date: does thiopental have a future in obstetric general anaesthesia? International Journal of Obstetric Anesthesia. 2013;22:175–8.
    1. Lucas DN, Yentis SM. Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports. Anaesthesia. 2015;70:375–9.
    1. McKeating K, Bali IM, Dundee JW. The effects of thiopentone and propofol on upper airway integrity. Anaesthesia. 1988;43:638–40.
    1. Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Anaesthesia. 2014;69:1089–101.
    1. Farmery AD. Simulating hypoxia and modelling the airway. Anaesthesia. 2011;66 S2:11–18.
    1. Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology. 1997;87:979–82.
    1. Tang L, Li S, Huang S, Ma H, Wang Z. Desaturation following rapid sequence induction using succinylcholine vs. rocuronium in overweight patients. Acta Anaesthesiologica Scandinavica. 2011;55:203–8.
    1. Abu-Halaweh SA, Massad IM, Abu-Ali HM, Badran IZ, Barazangi BA, Ramsay MA. Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium. Saudi Medical Journal. 2007;28:1393–6.
    1. Sorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. British Journal of Anaesthesia. 2012;108:682–9.
    1. Fuchs-Buder T, Schmartz D. The never ending story or the search for a nondepolarising alternative to succinylcholine. European Journal of Anaesthesiology. 2013;30:583–4.
    1. Girard T. Pro: rocuronium should replace succinylcholine for rapid sequence induction. European Journal of Anaesthesiology. 2013;30:585–9.
    1. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesthesia and Analgesia. 2007;104:575–81.
    1. Brown JP, Werrett GC. Bag-mask ventilation in rapid sequence induction. A survey of current practice among members of the UK Difficult Airway Society. European Journal of Anaesthesiology. 2015;32:446–8.
    1. Lawes EG, Campbell I, Mercer D. Inflation pressure, gastric insufflation and rapid sequence induction. British Journal of Anaesthesia. 1987;59:315–8.
    1. Petito SP, Russell WJ. The prevention of gastric inflation – a neglected benefit of cricoid pressure. Anaesthesia and Intensive Care. 1988;16:139–43.
    1. Maharaj CH, Costello JF, Harte BH, Laffey JG. Evaluation of the Airtraq® and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia. 2008;63:182–8.
    1. Malin E, Montblanc J, Ynineb Y, Marret E, Bonnet F. Performance of the Airtraq™ laryngoscope after failed conventional tracheal intubation: a case series. Acta Anaesthesiologica Scandinavica. 2009;53:858–63.
    1. Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope® Video Laryngoscope: randomized clinical trial in 200 patients. British Journal of Anaesthesia. 2005;94:381–4.
    1. Ndoko SK, Amathieu R, Tual L, et al. Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq™ laryngoscopes. British Journal of Anaesthesia. 2008;100:263–8.
    1. Jungbauer A, Schumann M, Brunkhorst V, Borgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. British Journal of Anaesthesia. 2009;102:546–50.
    1. Bathory I, Frascarolo P, Kern C, Schoettker P. Evaluation of the GlideScope® for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar. Anaesthesia. 2009;64:1337–41.
    1. Suzuki A, Toyama Y, Katsumi N, et al. The Pentax-AWS® rigid indirect videolaryngoscope: clinical assessment of performance in 320 cases. Anaesthesia. 2008;63:641–7.
    1. Maharaj CH, Costello JF, McDonnell JG, Harte BH, Laffey JG. The Airtraq® as a rescue airway device following failed direct laryngoscopy: a case series. Anaesthesia. 2007;62:598–601.
    1. Zaouter C, Calderon J, Hemmerling TM. Videolaryngoscopy as a new standard of care. British Journal of Anaesthesia. 2015;114:181–3.
    1. Dhonneur G, Ndoko S, Amathieu R, el Housseini L, Poncelet C, Tual L. Tracheal intubation using the Airtraq® in morbid obese patients undergoing emergency cesarean delivery. Anesthesiology. 2007;106:629–30.
    1. Riad W, Ansari T. Effect of cricoid pressure on the laryngoscopic view by Airtraq in elective caesarean section: a pilot study. European Journal of Anaesthesiology. 2009;26:981–2.
    1. Turkstra TP, Armstrong PM, Jones PM, Quach T. GlideScope® use in the obstetric patient. International Journal of Obstetric Anesthesia. 2010;19:123–4.
    1. Shonfeld A, Gray K, Lucas N, et al. Video laryngoscopy in obstetric anesthesia. Journal of Obstetric Anaesthesia and Critical Care. 2012;2:53.
    1. Arici S, Karaman S, Dogru S, et al. The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients. Turkish Journal of Medical Sciences. 2014;44:387–92.
    1. Aziz MF, Kim D, Mako J, Hand K, Brambrink AM. A retrospective study of the performance of video laryngoscopy in an obstetric unit. Anaesthesia and Analgesia. 2012;115:904–6.
    1. Bensghir M, Chkoura K, Elhassani M, Ahtil R, Azendour H, Kamili ND. Difficult intubation in a parturient with syringomyelia and Arnold-Chiari Malformation: use of Airtraq™ laryngoscope. Saudi Journal of Anaesthesia. 2011;5:419–22.
    1. Ni J, Luo L, Wu L, Luo D. The Airtraq™ laryngoscope as a first choice for parturients with an expected difficult airway. International Journal of Obstetric Anesthesia. 2014;23:94–5.
    1. Browning RM, Rucklidge MWM. Tracheal intubation using the Pentax Airway Scope videolaryngoscope following failed direct laryngoscopy in a morbidly obese parturient. International Journal of Obstetric Anesthesia. 2011;20:200–1.
    1. Tonidandel A, Booth J, D'Angelo R, Harris L, Tonidandel S. Anesthetic and obstetric outcomes in morbidly obese parturients: a 20-year follow-up retrospective cohort study. International Journal of Obstetric Anesthesia. 2014;23:357–64.
    1. Scott-Brown S, Russell R. Videolaryngoscopes and the obstetric airway. International Journal of Obstetric Anesthesia. 2015;24:137–46.
    1. Greenland KB, Segal R, Acott C, Edwards MJ, Teoh WHL, Bradley WPL. Observations on the assessment and optimal use of videolaryngoscopes. Anaesthesia and Intensive Care. 2012;40:622–30.
    1. Leong WL, Lim Y, Sia AT. Palatopharyngeal wall perforation during Glidescope Intubation. Anaesthesia and Intensive Care. 2008;36:870–4.
    1. Williams D, Ball DR. Palatal perforation associated with McGrath® videolaryngoscope. Anaesthesia. 2009;64:1144–5.
    1. Manickam BP, Adhikary SD. Re: soft palate perforation during orotracheal intubation facilitated by the GlideScope® videolaryngoscope. Journal of Clinical Anesthesia. 2008;20:401–2.
    1. Amundson AW, Weingarten TN. Traumatic GlideScope® video laryngoscopy resulting in perforation of the soft palate. Canadian Journal of Anesthesia. 2013;60:210–1.
    1. Benumof JL, Cooper SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. Journal of Clinical Anesthesia. 1996;8:136–40.
    1. Latto IP, Stacey M, Mecklenburgh J, Vaughan RS. Survey of the use of the gum elastic bougie in clinical practice. Anaesthesia. 2002;57:379–84.
    1. Hodzovic I, Latto IP, Henderson JJ. Bougie trauma – what trauma. Anaesthesia. 2003;58:192–3.
    1. Kadry M, Popat M. Pharyngeal wall perforation – an unusual complication of blind intubation with a gum-elastic bougie. Anaesthesia. 1999;54:404–5.
    1. Arndt GA, Cambray AJ, Tomasson J. Intubation bougie dissection of tracheal mucosa and intratracheal airway obstruction. Anesthesia and Analgesia. 2008;107:603–4.
    1. Knill RL. Difficult laryngoscopy made easy with a “BURP”. Canadian Journal of Anesthesia. 1993;40:279–82.
    1. Cantwell R, Clutton-Brock T, Cooper G, et al. Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. British Journal of Obstetrics and Gynaecology. 2011;118(S1):1–203.
    1. Haldar R, Samanta S, Bhagat H. Unexpected tracheal tube blockage from a semi-dissolved misoprostol tablet. International Journal of Obstetric Anesthesia. 2013;22:267–8.
    1. Rudraraju P, Eisen LA. Confirmation of endotracheal tube position: a narrative review. Journal of Intensive Care Medicine. 2009;24:283–92.
    1. Pfeiffer P, Bache S, Isbye DL, Rudolph SS, Rovsing L, Børglum J. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography. Acta Anaesthesiologica Scandinavica. 2012;56:571–6.
    1. Joffe AM, Hetzel S, Liew EC. A two-handed jaw-thrust technique is superior to the one-handed “EC-clamp” technique for mask ventilation in the apneic unconscious person. Anesthesiology. 2010;113:873–9.
    1. Koay CK, Yoong CS, Kok P. A randomized trial comparing two laryngeal mask airway insertion techniques. Anaesthesia and Intensive Care. 2001;29:613–5.
    1. Harry RM, Nolan JP. The use of cricoid pressure with intubating laryngeal mask. Anaesthesia. 1999;54:656–9.
    1. Brain AIJ, Verghese C. Correct fixation of LMA ProSeal™. Anaesthesia. 2003;58:922.
    1. Bick E, Bailes I, Patel A, Brain AIJ. Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care. Anaesthesia. 2014;69:1304–8.
    1. Winther LP, Mitchell AU, Moller AM. Failed intubation and subsequent airway management during Caesarean section in general anaesthesia. Ugeskrift for Laeger. 2010;172:1914–6.
    1. Kristensen MS, Teoh WH, Baker PA. Percutaneous emergency airway access; prevention, preparation, technique and training. British Journal of Anaesthesia. 2015;114:357–61.
    1. Dinsmore J, Heard AMB, Green RJ. The use of ultrasound to guide time-critical cannula tracheotomy when anterior neck airway anatomy is unidentifiable. European Journal of Anaesthesiology. 2011;28:506–10.
    1. Royal College of Obstetricians and Gynaecologists. Maternal Collapse in Pregnancy and the Puerperium. London: RCOG; 2011. Green-top Guideline No. 56.
    1. Hurford D, Laxton C. Obstetric, “wake up and proceed” survey. International Journal of Obstetric Anesthesia. 2011;20:S44.
    1. Fitzgerald E, Hodzovic I, Smith AF. ‘From darkness into light’: time to make awake intubation with videolaryngoscopy the primary technique for an anticipated difficult airway? Anaesthesia. 2015;70:387–92.
    1. Leslie D, Stacey M. Awake intubation. Continuing Education in Anaesthesia, Critical Care and Pain. 2015;15:64–7.
    1. Meek T, Vincent A, Duggan JE. Cricoid pressure: can protective force be sustained? British Journal of Anaesthesia. 1998;80:672–4.
    1. Gruenbaum SE, Gruenbaum BF, Tsaregorodtsev S, Dubilet M, Melamed I, Zlotnik A. Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report. Journal of Medical Case Reports. 2012;6:108.
    1. Mhyre JM, Riesner MN, Polley LS, Naughton NN. A series of anesthesia-related maternal deaths in Michigan, 1985-2003. Anesthesiology. 2007;106:1096–104.
    1. 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. International Journal of Obstetric Anesthesia. 2008;17:292–7.
    1. Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67:318–40.
    1. Malik D, Mushambi M, Ali P, Dravid MR. Tracheal extubation practices amongst members of the Difficult Airway Society: a national survey. Anaesthesia. 2013;68:656.
    1. Lo WK, Chong JL. Neck haematoma and airway obstruction in a pre-eclamptic patient: a complication of internal jugular vein cannulation. Anaesthesia and Intensive Care. 1997;25:423–5.
    1. Garcia-Rodriguez CR, Yentis SM. Carotid artery puncture, airway obstruction and the laryngeal mask airway in a preeclamptic patient. International Journal of Obstetric Anesthesia. 1996;5:194–7.
    1. NHS Patient Safety First. 2015. Quick Guide to Briefing/Debriefing (accessed 20/07/2015)
    1. National Patient Safety Agency. 2010. ‘How to Guide’. Five Steps to Safer Surgery (accessed 20/07/2015)
    1. Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthesia: a closed claims analysis. Anesthesiology. 1999;91:1703–11.
    1. Errando CL, Sigl JC, Robles M, et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. British Journal of Anaesthesia. 2008;101:178–85.
    1. Difficult Airway Society. 2015. Airway Alert Form (accessed 20/07/2015)
    1. Wilkes M, Beattie C, Gardner C, McNarry AF. Difficult airway communication between anaesthetists and general practitioners. Scottish Medical Journal. 2013;58:2–6.
    1. Banks IC. The application of Read Codes to anaesthesia. Anaesthesia. 1994;49:324–7.
    1. Joy S, Wilson R. Airway and Intubation problems during general anaesthesia for caesarean section. In: Colvin JR, Peden C, editors. Raising the Standard: a Compendium of Audit Recipes for Continuous Quality Improvement in Anaesthesia. 3rd edn. London: Royal College of Anaesthetists; 2012. pp. 224–5.
    1. Heard AMB, Green RJ, Eakins P. The formulation and introduction of a ‘can't intubate, can't ventilate’ algorithm into clinical practice. Anaesthesia. 2009;64:601–8.
    1. Boet S, Borges BCR, Naik VN, et al. Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session. British Journal of Anaesthesia. 2011;107:533–9.
    1. Konrad C, Schupfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesthesia and Analgesia. 1998;86:635–9.
    1. Cortellazzi P, Caldiroli D, Byrne A, Sommariva A, Orena EF, Tramacere I. Defining and developing expertise in tracheal intubation using a Glidescope® for anaesthetists with expertise in Macintosh direct laryngoscopy: an in-vivo longitudinal study. Anaesthesia. 2015;70:290–5.
    1. Obstetric Anaesthetists' Association, Association of Anaesthetists of Great Britain and Ireland. Guidelines for Obstetric Anaesthetic Services 2013. London: AAGBI; 2013.
    1. Mahajan RP. Critical incident reporting and learning. British Journal of Anaesthesia. 2010;105:69–75.
    1. Weiser TG, Haynes AB, Dziekan G, et al. Effect of a 19-item Surgical Safety Checklist during urgent operations in a global patient population. Annals of Surgery. 2010;251:976–80.
    1. Marshall SD, Mehra R. The effects of a displayed cognitive aid on non-technical skills in a simulated ‘can't intubate, can't oxygenate’ crisis. Anaesthesia. 2014;69:669–77.
    1. Babolhavaeji F, Rees I, Maloney D, Walker J, Knights M. Checklists for emergency induction of anaesthesia in critical care. Anaesthesia. 2013;68:661.
    1. Ziewacz JE, Arriaga AF, Bader AM, et al. Crisis checklists for the operating room: development and pilot testing. Journal of the American College of Surgeons. 2011;213:212–17.
    1. The Vortex Approach. 2013. The Vortex (accessed 19/07/2015)
    1. Jenkins B. Cognitive aids: time for a change? Anaesthesia. 2014;69:660–4.
    1. Association of Anaesthetists of Great Britain and Ireland. Checking Anaesthetic Equipment 2012. Anaesthesia. 2012;67:660–8.
    1. Thomas A, Parsons KA, Meer C, Woolnough M, Roberts F. Obstetric failed intubation case series: avoiding the chaos of an emergency caesarean section under general anaesthesia: are you “H.A.P.P.E”.? International Journal of Obstetric Anesthesia. 2014;23:S21.
    1. James B, Bryant H, Swales H, Al-Rawi S. Obstetric general anaesthetic safety checklist: guideline development through team simulation. International Journal of Obstetric Anesthesia. 2015;24:S24.
    1. Pandit JJ, Popat MT, Cook TM, et al. The Difficult Airway Society ‘ADEPT’ guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia. 2011;66:726–37.
    1. El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesthesia and Analgesia. 1996;82:1197–204.
    1. Ezri T, Gewurtz G, Sessler DI, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111–4.
    1. Magboul MA. The dilemma of Airway Assessment and evaluation. Internet Journal of Anesthesiology. 2004;10 (accessed 22/04/2015)
    1. Mallampati SR, Gatt SP, Gugino LD, et al. A Clinical sign to predict difficult tracheal intubation: a prospective study. Canadian Anaesthetists' Society Journal. 1985;32:429–34.
    1. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult Intubation. British Journal of Anaesthesia. 1988;61:211–6.
    1. Lundstrom LH, Moller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology. 2009;110:266–74.
    1. Kheterpal S, Han R, Tremper KK, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105:885–91.
    1. Ramachandran SK, Mathis MR, Tremper KK, Shanks AM, Kheterpal S. Predictors and clinical outcomes from failed Laryngeal Mask Airway Unique. A study of 15,795 patients. Anesthesiology. 2012;116:1217–26.

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