The Use of Video Laryngoscopy In Pregnant Women Undergoing Non-Obstetric Surgery

This quality improvement project looks at the proposed implementation of endotracheal intubation guidelines regarding pregnant patients undergoing non-obstetric surgery and how the use of video laryngoscopy versus the traditional practice will affect the first pass rate of the endotracheal tube intraoperatively. Statistics show that 2% of women undergo non-obstetric related surgery during pregnancy. Physiological changes during pregnancy, including increased laryngeal mucosa swelling and higher metabolic oxygen consumption, result in a heightened risk of apnea and hypoxemia during intubation. Pregnant women experience an eightfold higher incidence of failed intubation compared to non-pregnant populations. The number of patients classified as Mallampati 4 increased by 34% from 12 to 38 weeks of gestation. In traditional practice, direct laryngoscopy with either a Macintosh blade or a Miller blade is a popular first-line intubation method. Video laryngoscope devices like the McGrath and Glidescope offer real-time airway visualization, improving intubation success rates by providing superior glottic views without requiring alignment of the oral, laryngeal, and pharyngeal axes. Despite video laryngoscopy showing higher first-pass success rates, its usage remains limited among anesthesia providers in obstetrics. Implementing video laryngoscopy as a standard for patients at 20 weeks of gestation could reduce maternal mortality. The proposed implementation will occur over one year at an urban level-one trauma facility. This quality improvement initiative aims to improve patient safety and minimize anesthesia-related mortality by promoting video laryngoscopy usage in at least 75 cases, ensuring sustainable integration into clinical practice