Medical Student Research Fellowship for Summer 2009

Mentor: Dr. Weike Tao
Department: Anesthesiology and Pain Management
Room number: F2.222
Mail Code: 9068
Phone number: 214-648-4840
E-mail: Weike.Tao@UTSouthwestern.edu
Project title: Complications of Obstetric Anesthesia-Pre-exam Predictors of a Difficult Airway

Human subjects IRB approved project number (where applicable): 0502-305

Animal subjects IRB approved project number (where applicable): N.A.

Project Type: Health Records Review

Brief Description of Project:

Question Asked:
Are there pre-exam clues that can help predict a difficult airway?
Background:
Obstetric patients are more difficult to intubate than non-pregnant patients. Physiologic changes in obstetric patients that may predispose them to a difficult airway include upper airway edema, breast enlargement, excessive weight gain, decreased functional residual capacity, and increased oxygen consumption.1 A failed airway is the most common cause of anesthetic-related maternal mortality,1-3 and the difficulty of the issue is compounded by the urgency of many of these situations and the consideration of the needs of the fetus.
The purpose of the study is to correlate pre- and post-operative airway evaluation with the intraoperative encounter to identify factors that may help predict a difficult or non-intubatable airway so that alternative anesthesia types can be used or additional airway equipment be made available. It also will address the question of whether and how much more difficult the obstetric airway is given the current drugs and equipment available.
Information obtained from the study will help provide guidelines for obstetric anesthesia providers to identify patients with a difficult airway and aid in the provider's decision to apply general vs. regional anesthesia in order to maximize safety for obstetric patients.

Student's Involvement:

Over two-thousand obstetric patient charts have been retrieved with extensive pre-operative and intra-operative information related to the assessment of a difficult airway. The student will identify patients with difficult or failed airway intubation, and identify risk factors already collected, such as mouth opening, neck movement range, body weight, neck circumference. The majority of the information has been collected in a spreadsheet, but review of medical records may be necessary to examine the details of the intraoperative encounter. The student will have an opportunity to learn SPSS and perform statistical analysis on the gathered data. The results of the project could change the management of obstetric patients in which doctors can predict ahead of time the risks of airway management for an individual patient, and elect to perform general or regional anesthesia accordingly.

References:

1. Arkoosh, Valerie. "Airway management for C sections." Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine. 25 July 2007. University of Pennsylvania School of Medicine. 14 Mar. 2009.
2. Ezri, Tiberiu, Peter Szmuk, Shmuel Evron, Daniel Geva, Zion Hagay, and Jeffrey Katz. "Difficult Airway in Obstetric Anesthesia: A Review." Obstetrical and Gynecological Survey 56 (2001): 631-41.
3. Finucane, Brendan T. Complications of Regional Anesthesia. Springer, 2007. Pg 255-256

Previous Research Activities or Publications with Medical Students:

None