Airway management in a parturient with suspected airway edema: what should be the plan?

• A. Proceed with rapid intubation under general anesthesia without airway assessment.
• B. Preoxygenate and proceed with standard airway plan with possible video laryngoscope only.
• C. Prepare for potential difficult airway, preoxygenate, consider awake fiberoptic intubation if indicated, and have difficult airway cart ready.
• D. Delay airway management until edema resolves.

Answer: (C)

In a parturient with suspected airway edema, the priority is to anticipate a difficult airway and protect ventilation while the airway is secured. The best plan combines thorough preoxygenation, maintaining spontaneous breathing, a strategy for a potentially difficult airway, and readiness with backup devices and expertise.

Preoxygenation is essential because pregnancy reduces functional residual capacity and increases oxygen consumption, so desaturation can occur rapidly if ventilation becomes difficult. By maximizing oxygen stores and using a plan that preserves spontaneous respiration, you buy time and safety if airway access is challenging.

Awake fiberoptic intubation is considered when airway edema is anticipated because it allows airway control without losing the patient’s own breathing and airway tone. Performing the intubation while the patient remains awake and spontaneously breathing reduces the risk of complete airway loss if external edema makes airway passage uncertain. Topical anesthesia and careful sedation minimize discomfort and coughing while maintaining cooperation and oxygenation.

Having a difficult airway cart readily available ensures that all contingencies are at hand: multiple laryngoscope blades and video devices, fiberoptic equipment, supraglottic airway devices, and a plan for emergency airway access if needed. Clear communication and a defined backup strategy, including involvement of experienced staff early, improve safety in these high-stakes situations.

Delaying airway management until edema resolves is not appropriate in this context, and proceeding with a routine rapid sequence plan without assessment risks a unanticipated difficult airway and difficult ventilation, which can be catastrophic in the obstetric patient. While alternative approaches like regional anesthesia may be considered if feasible to avoid airway manipulation, the overall approach emphasizes preparation, oxygenation, and options that preserve airway control in the face of edema.