Obstetric Anaesthesia Annual Scientific Meeting 2026

Preparing for Obstetric Airway Emergencies through Simulation Training

Eleanor Tanqueray, Tom Houston, Dipali Verma

Department of Anaesthesia, Liverpool Women's Hospital

Introduction:

• Failed intubation is more common in obstetrics than the general population1

• The joint Obstetric Anaesthetists Association (OAA) and Difficult Airway Society (DAS) guidelines1 differ from standard DAS adult protocols2

• Rehearsal of a failed intubation drill is a curriculum requirement for completion of Entrustable Professional Activity 4 of the Initial Assessment of Competence in Obstetric Anaesthesia3

• Annual emergency front-of-neck-access (eFONA) training is recommended for all anaesthetists4

Aim:

Introduce regular obstetric airway simulation, including eFONA, for anaesthetic residents at Liverpool Women’s Hospital.

Methods:

A simulation session was developed:

• Scenario: Category 1 Cesarean under GA à failed intubation à “Can’t Intubate, Can’t Oxygenate” (CICO) à eFONA

• Part 1: Pre-op assessment, induction, application of OAA/DAS failed intubation algorithm (See fig. 1 and 4)

• Part 2: Demonstration, discussion and mannikin practice of eFONA (See fig. 2 and 3)

• Evaluation: Pre- and post-session surveys assessing prior exposure, confidence and feedback

Reults:

• 49 anaesthetic doctors participated (CT2-ST7, SAS, clinical fellows) between January 2024 – February 2025

• 36% had not practiced a CICO scenario in the previous year - see fig. 5

• Confidence in both algorithm use and eFONA improved significantly (p < 0.001) – see fig. 6

Challenges during implementation:

Challenge: Staffing pressures limited attendance

• Solution: Small groups (2-3) ensured adequate staffing

• Added benefits: Ample hands-on practice and safe educational environment

Challenge: Initial monthly sessions were resource heavy with low yield

• Solution: Departmental buy-in for dedicated slot during induction programme every 3 months

• Added benefits: Consistent sustainable delivery and widest reach of residents

Conclusion:

• This simulation training closes a critical training gap and is valued by residents

• Boosts confidence and strengthens preparedness, with potential to improve patient safety

• Integration into the induction programme has made delivery sustainable, maximising reach and impact

References:

1. Patel A, Pearce A, Pracy P & Vaughan R. (2015) Difficult Airway Society guidelines for the management of tracheal intubation in obstetrics. Anaesthesia, 70(11), 1286–1306. https://doi.org/10.1111/anae.13260

2. Frerk C, Mitchell V S, McNarry AF, Mendonca C, Bhagrath R, Patel A, O'Sullivan EP, Woodall NM, Ahmad I. (2015) Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia, 115(6), 827–848. https://doi.org/10.1093/bja/aev371

3. Cochran D, Budd J, Brennan C, Downs A. (2022) Initial Assessment of Competence in Obstetric Anaesthesia, Entrustable Professional Activities 3 and 4. https://www.rcoa.ac.uk/sites/default/files/documents/2023-11/EPA-3-4-2022.pdf

4. Qazi I, Mendonca C, Sajayan A, Boulton A & Ahmad I. (2019) Emergency front of neck airway: What do trainers in the UK teach? A national survey. Journal of Anaesthesiology Clinical Pharmacology, 35(3), 318–323. https://doi.org/10.4103/joacp.JOACP_65_18

Obstetric Anaesthesia Annual Scientific Meeting 2026

Improving preparedness for obstetric airway emergencies: integrating simulation training into a local induction programme

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