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Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis.

Publication ,  Journal Article
Reale, SC; Bauer, ME; Klumpner, TT; Aziz, MF; Fields, KG; Hurwitz, R; Saad, M; Kheterpal, S; Bateman, BT ...
Published in: Anesthesiology
May 2022

Estimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this study were to provide a contemporary estimate of the frequency of difficult and failed intubation in women undergoing general anesthesia for cesarean delivery and to elucidate risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery.This is a multicenter, retrospective cohort study utilizing the Multicenter Perioperative Outcomes Group database. The study population included women aged 15 to 44 yr undergoing general anesthesia for cesarean delivery between 2004 and 2019 at 1 of 45 medical centers. Coprimary outcomes included the frequencies of difficult and failed intubation. Difficult intubation was defined as Cormack-Lehane view of 3 or greater, three or more intubation attempts, rescue fiberoptic intubation, rescue supraglottic airway, or surgical airway. Failed intubation was defined as any attempt at intubation without successful endotracheal tube placement. The rates of difficult and failed intubation were assessed. Several patient demographic, anatomical, and obstetric factors were evaluated for potential associations with difficult intubation.This study identified 14,748 cases of cesarean delivery performed under general anesthesia. There were 295 cases of difficult intubation, with a frequency of 1:49 (95% CI, 1:55 to 1:44; n = 14,531). There were 18 cases of failed intubation, with a frequency of 1:808 (95% CI, 1:1,276 to 1:511; n = 14,537). Factors with the highest point estimates for the odds of difficult intubation included increased body mass index, Mallampati score III or IV, small hyoid-to-mentum distance, limited jaw protrusion, limited mouth opening, and cervical spine limitations.In this large, multicenter, contemporary study of more than 14,000 general anesthetics for cesarean delivery, an overall risk of difficult intubation of 1:49 and a risk of failed intubation of 1:808 were observed. Most risk factors for difficult intubation were nonobstetric in nature. These data demonstrate that difficult intubation in obstetrics remains an ongoing concern.

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Published In

Anesthesiology

DOI

EISSN

1528-1175

ISSN

0003-3022

Publication Date

May 2022

Volume

136

Issue

5

Start / End Page

697 / 708

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Pregnancy
  • Laryngoscopy
  • Intubation, Intratracheal
  • Humans
  • Female
  • Cohort Studies
  • Cervical Vertebrae
  • Anesthesiology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Reale, S. C., Bauer, M. E., Klumpner, T. T., Aziz, M. F., Fields, K. G., Hurwitz, R., … Multicenter Perioperative Outcomes Group Collaborators, . (2022). Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. Anesthesiology, 136(5), 697–708. https://doi.org/10.1097/aln.0000000000004173
Reale, Sharon C., Melissa E. Bauer, Thomas T. Klumpner, Michael F. Aziz, Kara G. Fields, Rachel Hurwitz, Manal Saad, Sachin Kheterpal, Brian T. Bateman, and Brian T. Multicenter Perioperative Outcomes Group Collaborators. “Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis.Anesthesiology 136, no. 5 (May 2022): 697–708. https://doi.org/10.1097/aln.0000000000004173.
Reale SC, Bauer ME, Klumpner TT, Aziz MF, Fields KG, Hurwitz R, et al. Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. Anesthesiology. 2022 May;136(5):697–708.
Reale, Sharon C., et al. “Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis.Anesthesiology, vol. 136, no. 5, May 2022, pp. 697–708. Epmc, doi:10.1097/aln.0000000000004173.
Reale SC, Bauer ME, Klumpner TT, Aziz MF, Fields KG, Hurwitz R, Saad M, Kheterpal S, Bateman BT, Multicenter Perioperative Outcomes Group Collaborators. Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. Anesthesiology. 2022 May;136(5):697–708.

Published In

Anesthesiology

DOI

EISSN

1528-1175

ISSN

0003-3022

Publication Date

May 2022

Volume

136

Issue

5

Start / End Page

697 / 708

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Pregnancy
  • Laryngoscopy
  • Intubation, Intratracheal
  • Humans
  • Female
  • Cohort Studies
  • Cervical Vertebrae
  • Anesthesiology