Difficult and failed intubation in caesarean general anaesthesia: a four-year retrospective review.

INTRODUCTION General anaesthesia is associated with higher maternal morbidity and mortality, when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for caesarean delivery at a high-volume obstetric hospital in Singapore. METHODS All parturients who underwent caesarean delivery under general anaesthesia in 2013-2016 were identified and medical records reviewed to extract pertinent data. Difficult intubation was defined as those "requiring more than one attempt at intubation, or documented as such, based on the opinion of the anaesthetist." A failed intubation was defined as "the inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management." RESULTS Records of 660 caesarean sections under general anaesthesia were extracted. Mean age of parturients was 32.1 ± 5.5 years and median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m2. Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, giving an incidence of 5.0%. Junior trainees performed 90% of all intubations and 28 of 33 (84.8%) difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (15.0%). No instance of failed intubation was reported. CONCLUSION The local incidence of difficult obstetric intubation was 1 in 20. There was no failure of intubation.