Difficult and failed intubation in obstetrics.

Obstetric general anaesthesia is associated with a number of deleterious effects and it has long been recognized that airway management can be challenging and tracheal intubation more likely to fail. Failed intubation and subsequent inadequate ventilation is an important cause of maternal mortality and morbidity. General anaesthesia for Caesarean section has dramatically declined in many nations around the world and it is used disproportionately more frequently for category 1 Caesarean section (immediate risk to life of mother or fetus) because of the perceived need for urgent delivery of the fetus. In this pressured situation, patient assessment, positioning, and preoxygenation may be compromised and anxiety may impair the performance of the anaesthetist. A number of interesting developments have occurred over the last 5 yr which may already be influencing how the obstetric airway is managed. Rigid indirect laryngoscopy has become increasingly popular for performing tracheal intubation, established notions of the role muscle relaxation plays in difficult airway management have been questioned, and a novel drug which permanently reverses nondepolarizing neuromuscular block has entered clinical practice. These changes have implications for the modern and safe management of difficult and failed intubation in obstetrics.