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Abstract
Background and aims The Fourth National Audit Project investigating airway complications found that sub-standard airway assessments secondary to omissions, inexperience and inadequate preparation contributed to poor outcomes.
Obstetric populations are high risk for encountering difficult airways, compounded by increases in maternal obesity and co-morbidities. Labouring women with epidurals in-situ often require emergency operative intervention (19.6%), and potentially intubation.
Numerous factors contribute to sub-optimal airway assessment, including time, staffing pressures, stress, and anaesthetists grade.
Therefore, thorough airway assessments should be documented when epidurals are sited, maximising opportunities to foresee airway issues, to reduce risk, seek consultant support, and strategise for a safer airway. This follows current joint Obstetric Anaesthetists’ Association and Difficult Airway Assessment guidelines.
Methods Prospective data collection evaluated the presence and quality of airway assessment on current epidural placement documents. Good quality assessment were defined as three or more assessment tools e.g: Mallampati, mouth opening, jaw/neck movement, thyromental/sternomental distances. After this snapshot of practice, the epidural proforma was edited to include mandatory airway assessment. the data collection cycle was repeated.
Results We highlighted, of 103 cases, airway assessment was documented in 18%. of those, 52% were of poor quality. Prompting on the epidural chart led to significant improvement in documentation in the following 30 patients, with airway assessments increasing to 57%. ‘Good quality’ assessments rose to 72%.
Conclusions Quality airway assessment should occur at the time of epidural placement. An integrated ‘airway prompt’ to the epidural proforma improved compliance significantly towards safer practice.