Airway changes during Cesarean hysterectomy

Purpose: To document whether hemorrhage and fluid administration during per ipartum hysterectomy results in changes in the airway that may predispose t o subsequent difficult intubation, in the event that intraoperative general anesthesia is required during regional anesthesia. Clinical features: A 32-yr-old underwent peripartum hysterectomy for placen ta accreta, Blood loss of 5.5 L occurred during surgery requiring 6 L cryst alloid, 1 L hetastarch, five units packed RBCs and two units fresh frozen p lasma, Airway changes were followed using Samsoon's modification of Mallamp ati airway classification, In addition, airway photographs were obtained us ing a Polaroid camera, The airway of the patient changed from class 2 preop eratively to class 4 in the immediate postoperative period, The airway grad ually returned to normal over the ensuing 48 hr, during which a negative fl uid balance of 4 L occurred due to substantial postoperative diuresis. Conclusion: Peripartum airway changes were detected during Cesarean hystere ctomy and fluid resuscitation that gradually returned to normal within 48 h r after surgery,