Failed intubation in a parturient with spina bifida

We describe a case of unexpected difficult intubation and ventilation durin g induction of general anaesthesia for caesarean section. This case was par ticularly challenging as the parturient suffered with particularly severe c ord tethering following surgery for spina bifida as a child. The observed c hange in anticipated intubation difficulty during pregnancy, and the use of the laryngeal mask airway as a life-saving device in obstetrics are descri bed. Consideration of the difficulties of anaesthetising the patient with s pina bifida for caesarean section in general, and the issues relevant in de ciding whether to continue with surgery or to wake the patient up in partic ular are discussed. Suggestions are made for the management of this emergen cy situation in those not skilled in fibreoptic intubation. (C) 2000 Harcou rt Publishers Ltd.