All India difficult airway association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

Venkateswaran Ramkumar, Ekambaram Dinesh, Sumalatha Radhakrishna Shetty, Amit Shah, Pankaj Kundra, Sabyasachi Das, Sheila Nainan Myatra, Syed Moied Ahmed, Jigeeshu Vasishtha Divatia, Apeksh Patwa, Rakesh Garg, Ubaradka S. Raveendra, Jeson Rajan, Dilip K. Pawar, Singaravelu Ramesh

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreopticguided intubation via the SAD or wake up the patient depends on the urgency of surgery, foetomaternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.

Original languageEnglish
Pages (from-to)899-905
Number of pages7
JournalIndian Journal of Anaesthesia
Volume60
Issue number12
DOIs
Publication statusPublished - 01-12-2016
Externally publishedYes

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Intubation
Obstetrics
India
Guidelines
Equipment and Supplies
Mothers
Intermittent Positive-Pressure Ventilation
Pressure
Insufflation
Airway Management
Expert Testimony
Apnea
Masks
Nose
Ventilation
Consensus
Fetus
Emergencies
Anesthesia
Parturition

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Ramkumar, Venkateswaran ; Dinesh, Ekambaram ; Shetty, Sumalatha Radhakrishna ; Shah, Amit ; Kundra, Pankaj ; Das, Sabyasachi ; Myatra, Sheila Nainan ; Ahmed, Syed Moied ; Divatia, Jigeeshu Vasishtha ; Patwa, Apeksh ; Garg, Rakesh ; Raveendra, Ubaradka S. ; Rajan, Jeson ; Pawar, Dilip K. ; Ramesh, Singaravelu. / All India difficult airway association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. In: Indian Journal of Anaesthesia. 2016 ; Vol. 60, No. 12. pp. 899-905.
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abstract = "The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95{\%}. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreopticguided intubation via the SAD or wake up the patient depends on the urgency of surgery, foetomaternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.",
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Ramkumar, V, Dinesh, E, Shetty, SR, Shah, A, Kundra, P, Das, S, Myatra, SN, Ahmed, SM, Divatia, JV, Patwa, A, Garg, R, Raveendra, US, Rajan, J, Pawar, DK & Ramesh, S 2016, 'All India difficult airway association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics', Indian Journal of Anaesthesia, vol. 60, no. 12, pp. 899-905. https://doi.org/10.4103/0019-5049.195482

All India difficult airway association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. / Ramkumar, Venkateswaran; Dinesh, Ekambaram; Shetty, Sumalatha Radhakrishna; Shah, Amit; Kundra, Pankaj; Das, Sabyasachi; Myatra, Sheila Nainan; Ahmed, Syed Moied; Divatia, Jigeeshu Vasishtha; Patwa, Apeksh; Garg, Rakesh; Raveendra, Ubaradka S.; Rajan, Jeson; Pawar, Dilip K.; Ramesh, Singaravelu.

In: Indian Journal of Anaesthesia, Vol. 60, No. 12, 01.12.2016, p. 899-905.

Research output: Contribution to journalArticle

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AU - Shah, Amit

AU - Kundra, Pankaj

AU - Das, Sabyasachi

AU - Myatra, Sheila Nainan

AU - Ahmed, Syed Moied

AU - Divatia, Jigeeshu Vasishtha

AU - Patwa, Apeksh

AU - Garg, Rakesh

AU - Raveendra, Ubaradka S.

AU - Rajan, Jeson

AU - Pawar, Dilip K.

AU - Ramesh, Singaravelu

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N2 - The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreopticguided intubation via the SAD or wake up the patient depends on the urgency of surgery, foetomaternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.

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