Abstract
Difficult or failed tracheal intubation is an important cause of anaesthetic-related maternal morbidity and mortality. The incidence of failed intubation in parturients is estimated to be as frequent as 1 in 500; that of mortality is unknown, although some 10–13 pregnant women in England, Scotland and Wales die each year because of anaesthetic-related complications. To prevent such catastrophes, all necessary monitors and equipment should be available, including that needed to deal with a failed intubation. Assessment of the patient may lead to preoperative recognition of a difficult airway; altered positioning may be of help both in recognition and management. Furthermore, adequate assistance, correct use of cricoid pressure, and confirmation of tracheal intubation are fundamental to safe practice. Lastly, should the anaesthetist fail to intubate the patient’s trachea, a management protocol is suggested.
Résumé
Une intubation trachéale difficile peut être lourde de conséquence chez la femme enceinte et on estime qu’elle échoue une fois sur cinq cent dans cette population. On ignore le nombre de décès qui lui sont attribuables mais, bon an, mal an, de 10 à 13 femmes enceintes meurent de complications anesthésiques en Angleterre, en Ecosse et au Pays de Galles. Pour prévenir ces tragédies, il faut avoir sous la main tous les moniteurs et instruments permettant de pallier à une intubation difficile ou ratée. L’examen pré-opératoire de la patiente révélera souvent les difficultés à venir et la meilleure position pour les contourner. Une assistance éclairé pourra exercer à bon escient une pression sur le cricoïde et aider à confirmer le succès de l’intubation. Enfin, nous vous proposons un plan d’action lorsque l’intubation s’avère impossible.
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Davies, J.M., Weeks, S., Crone, L.A. et al. Difficult intubation in the parturient. Can J Anaesth 36, 668–674 (1989). https://doi.org/10.1007/BF03005419
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DOI: https://doi.org/10.1007/BF03005419