ABSTRACT
General anaesthesia deaths relate to airway disasters, such as failure to intubate, oxygenate and ventilate. A pregnant woman is at higher risk of airway management difficulties than normal. This chapter summarises factors that increase the likelihood of airway difficulties at intubation and extubation in pregnant patients. Many detailed airway management algorithms have been published which deal with every potential complication. There is an increase in oxygen consumption of up to 16% at term, compared with non-pregnant controls. A pregnant woman with her increased oxygen requirement and decreased functional residual capacity will desaturate much faster, particularly if she is obese. Appropriate drugs for induction of anaesthesia and muscle relaxation should be available at all times in the obstetric unit. Oxygenation is most likely to be successful if a two-person, four-handed ventilation technique is used with an oropharyngeal airway. A purpose-designed cricothyroidotomy kit or jet ventilation catheter with a jet ventilator can be used to provide a surgical airway.
