Management Of Known Difficult Airway For Emergent Cesarean Delivery

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Braxton Adkins  
University of Kentucky


Regina Fragento  
University of Kentucky
Daniel Hopkins  
University of Kentucky
Shelly Ferrell  
University of Kentucky


A 33 year old female with five temporomandibular joint surgeries presented for induction of labor. She was told by anesthesiologists she was a "difficult airway" after last temporomandibular joint surgery and subsequent nasal surgery. Upon discussion with obstetric team, it was decided to place an early labor epidural which was functional for over 24 hours. The obstetric team then posted an emergent cesarean section due to nonreassuring fetal status. En route to OR, the epidural was dosed with lidocaine, subsequently chloroprocaine but sensory level remained below T10. A modified rapid sequence induction proceeded with propofol and succinylcholine with fiberoptic bronchoscope available. Mask ventilation was easy but intubation attempt was unsuccessful with fiberoptic bronchoscope. After a second unsuccessful intubation attempt, the surgical team proceeded with delivery during mask ventilation with cricoid pressure. An LMA was placed successfully for remainder of case. Daily "safety rounds" were subsequently implemented to ensure specific patient concerns are communicated among teams.

Professional Category:



Other - airway

Enter up to two references.

1. Chestnut, David H.. Chestnut's Obstetric Anesthesia: Principles and Practice. Sixth edition. Philadelphia, PA: Elsevier/Saunders, 2020.