Airway Management and Outcomes in Obstetric Patients Undergoing Cesarean Section Under General Anesthesia: A Retrospective Single-Center Descriptive Study

Background: Difficult airway management in obstetric patients remains a significant concern, as pregnancy-related physiological changes increase the risk of failed intubation and associated complications. This study examined the airway management strategies during cesarean sections under general anesthesia and evaluated their relationship with maternal outcomes, such as intubation attempts and oxygenation. Methods: This retrospective, descriptive cross-sectional study included 1986 pregnant patients (≥18 years, American Society of Anesthesiologists [ASA] II–III) who underwent tracheal intubation for cesarean section between January 1, 2016, and December 31, 2023. Demographic data, preoperative airway assessments, induction and airway techniques, and intraoperative physiological variables were extracted from electronic medical records. Statistical analyses were performed using SPSS version 22.0. Normality was tested using the Shapiro–Wilk test. Between-group comparisons employed the Student’s t-test for normally distributed continuous variables and the Mann–Whitney U test for non-normally distributed variables, while categorical variables were compared with χ2 tests. Logistic regression was performed for categorical predictors, and reference category comparisons were reported using regression p-values. Results: The median patient age was 31 years, and the median gestational age was 38 weeks. Most patients were classified as ASA II (85.2%) and had no comorbidities (84.4%). Video laryngoscopy (VL) was used in only 39 cases (2%), whereas direct laryngoscopy was used in 1947 cases; stylets or bougies were used in 153 cases. Use of VL was significantly associated with patient category, with higher utilization in cases of category three (p < 0.001). Thiopental use was associated with a higher number of intubation attempts compared to propofol (p = 0.031). Spearman’s correlation analysis revealed that the number of intubation attempts was negatively correlated with lowest oxygen saturation during intubation (r = –0.068, p = 0.003) and extubation (r = –0.069, p = 0.002), and positively correlated with peak airway pressure after intubation (r = 0.078, p = 0.001). Conclusion: VL remains underutilized in obstetric general anesthesia despite its potential benefits. These findings highlight the need for improved airway management strategies to enhance safety during cesarean deliveries.