Failed tracheal intubation in obstetric anaesthesia: 2 yr national case-control study in the UK.

Journal article

BACKGROUND: There are few national figures on the incidence of failed tracheal intubation during general anaesthesia in obstetrics. Recent small studies have quoted a rate of one in 250 general anaesthetics (GAs). The aim of this UK national study was to estimate this rate and identify factors that may be predictors. METHODS: Using the UK Obstetric Surveillance System (UKOSS) of data collection, a survey was conducted between April 2008 and March 2010. Incidence and associated risk factors were recorded in consultant-led UK delivery suites. Units reported the details of any failed intubation (index case) and the two preceding GA cases (controls). Predictors were evaluated using multivariable logistic regression, significance P<0.05 (two-sided). RESULTS: We received 57 completed reports (100% response). The incidence using a unit-based estimation approach was one in 224 (95% confidence interval 179-281). Univariate analyses showed the index cases to be significantly older, heavier, with higher BMI, with Mallampati score recorded and score >1. Multivariate analyses showed that age, BMI, and a recorded Mallampati score were significant independent predictors of failed tracheal intubation. The classical laryngeal mask airway was the most commonly used rescue airway (39/57 cases). There was one emergency surgical airway but no deaths or hypoxic brain injuries. Gastric aspiration occurred in four (8%) index cases. Index cases were more likely to have maternal morbidities (P=0.026) and many babies in both groups were admitted to the neonatal intensive care unit: 21 (37%) vs 29 (27%) (NS). Three babies died--all in the control group.

Authors: Quinn, A; Milne, D; Columb, M; Gorton, H; Knight, M

• Publication status: Published
• Journal: British journal of anaesthesia
• Volume: 110
• Issue: 1
• Pages: 74-80
• Publication date: 2013-01-01
• DOI: 10.1093/bja/aes320
• EISSN: 1471-6771
• ISSN: 0007-0912
• Language: English
• Keywords: Adult; Laryngeal Masks; Pneumonia, Aspiration; Infant, Newborn; Hospital Mortality; Intubation, Intratracheal; Treatment Failure; Logistic Models; Great Britain; Case-Control Studies; Time Factors; Body Mass Index; Age Factors; Female; Anesthesia, Obstetrical; Infant Mortality; Antacids; Risk Factors; Humans; Airway Management; Pregnancy