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Obstetricians’ Ability to Assess the Airway

From the Departments of Anesthesiology and Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.

Address reprint requests to: Robert R. Gaiser, MD Department of Anesthesiology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104 E-mail: gaiserr{at}mail.med.upenn.edu

Objectives: To assess the ability of obstetricians to recognize parturients at risk for difficult intubation and to examine the effect of education in airway examination on that ability.

Methods: The airways of 160 parturients were examined by four physicians: one attending and one resident obstetrician, and one attending and one resident anesthesiologist. After each airway examination, the physicians completed questionnaires about possible difficult intubation, use of antepartum consultation, and choice of analgesia early in labor.

Results: Instruction in airway examination did not affect obstetricians’ ability to assess airways. Compared with the attending anesthesiologist’s opinion, the sensitivity and specificity of the attending obstetrician before instruction were 0.59 and 0.82, respectively, and for the obstetric resident, 0.41 and 0.89, respectively. After instruction, the sensitivity and specificity for the obstetric attending physician were 0.60 and 0.83, respectively and for the obstetric resident, 0.50 and 0.87, respectively. In airways judged possible difficult intubations by the obstetricians, instruction did not affect the use of antepartum consultation or early epidural analgesia by the residents. In the obstetric attending physicians there was a significant increase in use of early epidural analgesia.

Conclusion: Although instruction in airway examination did not affect obstetricians’ ability to predict difficult airways, it did affect treatment of labor analgesia.