**4.4 Management of the anticipated difficult airway**

Anticipated difficult airway is defined as a clinical situation in which a trained anesthesiologist has anticipated difficulty in providing ventilation using facemask or a supraglottic airway, laryngoscopy, tracheal intubation, extubation, or invasive airway [104]. In pregnant women with an anticipated difficult airway, neuraxial anesthesia is more preferred compared with general anesthesia as it does not require any airway manipulation. However, anesthetist should always have backup plan for securing the airway in case high or failed block happened. If pregnant women with anticipated difficult airway must undergo general anesthesia, the safest option is to perform awake tracheal intubation [2].

## **4.5 Extubation of the trachea**

Pulmonary aspiration is the one of the most common adverse events at the end of anesthesia, especially during the extubation [6, 105]. In obstetric patients, awake extubation is recommended. The position during extubation is also important to prevent regurgitation [49]. Recent study suggests a head-up position because it aids the patency of airway, respiratory function, and access to the airway [106].
