Date of Award

Spring 5-5-2026

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Advisor

Brian Garrett, DNP, CRNA

First Committee Member

Danielle Winch, DNP, APRN-CNP

Second Committee Member

Amy Bishop, DNP, AGCNS-BC

Third Committee Member

Joy Shoemaker, DNP, APRN, FNP-BC, CNE

Keywords

video laryngoscopy, difficult airway, airway management, pregnancy, non-obstetric surgery

Subject Categories

Medicine and Health Sciences

Abstract

This quality improvement project looks at the proposed implementation of endotracheal intubation guidelines regarding pregnant patients undergoing non-obstetric surgery and how the use of video laryngoscopy versus the traditional practice will affect the first pass rate of the endotracheal tube intraoperatively. Statistics show that 2% of women undergo non-obstetric related surgery during pregnancy. Physiological changes during pregnancy, including increased laryngeal mucosa swelling and higher metabolic oxygen consumption, result in a heightened risk of apnea and hypoxemia during intubation. Pregnant women experience an eightfold higher incidence of failed intubation compared to non-pregnant populations. The number of patients classified as Mallampati 4 increased by 34% from 12 to 38 weeks of gestation. In traditional practice, direct laryngoscopy with either a Macintosh blade or a Miller blade is a popular first-line intubation method. Video laryngoscope devices like the McGrath and Glidescope offer real-time airway visualization, improving intubation success rates by providing superior glottic views without requiring alignment of the oral, laryngeal, and pharyngeal axes. Despite video laryngoscopy showing higher first-pass success rates, its usage remains limited among anesthesia providers in obstetrics. Implementing video laryngoscopy as a standard for patients at 20 weeks of gestation could reduce maternal mortality. The proposed implementation will occur over one year at an urban level-one trauma facility. This quality improvement initiative aims to improve patient safety and minimize anesthesia-related mortality by promoting video laryngoscopy usage in at least 75 cases, ensuring sustainable integration into clinical practice

Acknowledgement 1

1

Acknowledgement 2

1

Licensing Permission

Copyright, all rights reserved. Fair Use

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