Airway challenges in pregnancy
Pregnancy carries an eightfold increased risk of failed intubation(17).
The main reason is the increased vascularity and edema of the
respiratory mucosa(18). Therefore, a smaller size endotracheal tube
should be used. In addition, due to increased O2consumption in pregnancy and decreased oxygen reserve, a more
precipitous drop in PaO2 is anticipated during
intubation(18). Optimal pre-oxygenation without hyperventilation will
minimize the magnitude of desaturation. An obstetrically trained
anesthesiologist should perform the intubation. It is the standard
practice at our institution that they are present for non-emergent
intubations outside the obstetrical care unit. The availability of an
obstetrically trained anesthesiologist offers the necessary support for
airway management during proning, eliminating the hesitation to prone a
pregnant patient.