Indian Journal of Anaesthesia

GUIDELINES 2 (AIDAA)
Year
: 2016  |  Volume : 60  |  Issue : 12  |  Page : 899--905

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics


Venkateswaran Ramkumar1, Ekambaram Dinesh1, Sumalatha Radhakrishna Shetty2, Amit Shah3, Pankaj Kundra4, Sabyasachi Das5, Sheila Nainan Myatra6, Syed Moied Ahmed7, Jigeeshu Vasishtha Divatia6, Apeksh Patwa3, Rakesh Garg8, Ubaradka S Raveendra2, Jeson Rajan Doctor6, Dilip K Pawar9, Singaravelu Ramesh10 
1 Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
3 Kailash Cancer Hospital and Research Centre, Muni Seva Ashram; Department of Anaesthesiology and Critical Care, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
4 Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
5 Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India
6 Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
7 Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
8 Department of Onco Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
9 Former Professor, Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
10 Department of Paediatric Anaesthesia, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
Ekambaram Dinesh
Department of Anaesthesiology, Kasturba Medical College, Manipal 576 104, Karnataka
India

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 H 2 O 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 SpO 2 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 fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.


How to cite this article:
Ramkumar V, Dinesh E, Shetty SR, Shah A, Kundra P, Das S, Myatra SN, Ahmed SM, Divatia JV, Patwa A, Garg R, Raveendra US, Doctor JR, Pawar DK, Ramesh S. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics.Indian J Anaesth 2016;60:899-905


How to cite this URL:
Ramkumar V, Dinesh E, Shetty SR, Shah A, Kundra P, Das S, Myatra SN, Ahmed SM, Divatia JV, Patwa A, Garg R, Raveendra US, Doctor JR, Pawar DK, Ramesh S. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. Indian J Anaesth [serial online] 2016 [cited 2017 Mar 24 ];60:899-905
Available from: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2016;volume=60;issue=12;spage=899;epage=905;aulast=Ramkumar;type=0