Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type.

There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. We propose that intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with appropriately applied cricoid pressure. We found no other case reports of difficult intubation in patients with Ehlers-Danlos syndrome, hypermobility type. There are reports of cervical spine instability and temporomandibular joint dysfunction in patients with this syndrome suggesting a potential for difficult airway management. Additional anaesthetic problems associated with Ehlers-Danlos syndrome involve patient positioning and vascular access.

Comparison of cricothyroidotomy on manikin vs. simulator: a randomised cross-over study.

We compared the time taken to perform cricothyroidotomy on a manikin to that on a medium fidelity simulator, to assess the effect of psychological stress and time pressure on performance. Seventy anaesthetists participated in this randomised cross-over study. Fifty-four (77%) anaesthetists took longer on the simulator, with the mean (SD) time taken to perform the procedure on the manikin and simulator 34 (18) and 48 (11) s, respectively (p < 0.001). Anaesthetists with more experience performed the procedure more quickly on both manikin and simulator. We conclude that psychological stress and time pressure in real-life scenarios can affect the performance of cricothyroidotomy.