Difficult and Failed Tracheal Intubation in Cesarean Deliveries: A Review of 4330 Cases

Sadaf Mushtaq; Maimoona Zahid; Shamila Athar Siddiqui; Khalid Bashir; Arshad Taqi

doi:10.54112/bcsrj.v7i3.2199

Authors

Sadaf Mushtaq Department of Anesthesia, Kaul Associates, Hamdard Latif Hospital, Lahore, Pakistan
Maimoona Zahid Department of Anesthesia, Kaul Associates, Hamdard Latif Hospital, Lahore, Pakistan
Shamila Athar Siddiqui Department of Anesthesia, Kaul Associates, Hamdard Latif Hospital, Lahore, Pakistan
Khalid Bashir Department of Anesthesia, Kaul Associates, Hamdard Latif Hospital, Lahore, Pakistan
Arshad Taqi Department of Anesthesia, Kaul Associates, Hamdard Latif Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i3.2199

Keywords:

Cesarean Section, Tracheal Intubation, Difficult Airway, Obstetric Anesthesia, General Anesthesia, Airway Management, Rapid Sequence Induction, Maternal Safety

Abstract

Difficult and failed tracheal intubation during cesarean delivery under general anesthesia represents a significant patient safety concern in obstetric anesthesia. Physiological changes during pregnancy increase airway management challenges and may lead to serious maternal and neonatal complications. Data from resource-limited settings remains limited. Objective: To determine the incidence of difficult and failed tracheal intubation during cesarean delivery under general anesthesia and to evaluate airway characteristics and management strategies. Methods: This retrospective observational study was conducted at Hameed Latif Hospital, Lahore, Pakistan. Medical records of women who underwent cesarean delivery under general anesthesia between January 2014 and December 2016 were reviewed. Out of 5,637 cesarean sections performed during the study period, 4,330 cases with complete anesthesia records were included. Data regarding demographic characteristics, comorbidities, airway assessment parameters, laryngoscopic view, and airway management techniques were extracted. Difficult intubation was defined as intubation requiring more than one attempt or additional airway adjuncts, while failed intubation referred to the inability to secure the airway during rapid sequence induction. Data were analyzed using SPSS version 22 and presented as mean ± standard deviation or frequencies and percentages. Results: A total of 4,330 patients were analyzed. The mean maternal age was 28.98 ± 4.52 years, and the mean BMI was 30.12 ± 5.16 kg/m². Most participants were classified as ASA II (98.5%), and 76.6% underwent elective cesarean section. Mallampati grade II was the most common airway classification (41.9%), and Cormack–Lehane grade I laryngoscopic view was observed in 68.2% of patients. Difficult or failed tracheal intubation occurred in 30 cases (0.69%). Difficult intubation was observed in 29 patients (0.67%), whereas failed intubation occurred in one patient (0.02%). Among difficult airway cases, airway management was successfully achieved using a stylet with BURP maneuver (17 cases), gum elastic bougie (6 cases), a second attempt by a senior consultant (4 cases), and fiberoptic bronchoscopy (2 cases). Conclusion: The incidence of difficult and failed tracheal intubation during cesarean delivery under general anesthesia was low in this cohort. Careful preoperative airway assessment, availability of airway adjuncts, and experienced anesthesiology supervision appear to contribute to successful airway management and improved maternal safety.

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